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J Thorac Cardiovasc Surg 2006;132:1469-1470
© 2006 The American Association for Thoracic Surgery

Brief Communication

Hybrid repair of mitral paravalvular leak: Open surgical placement of a percutaneous occluder device

^a Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
^b Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
^c Division of Cardiac Anesthesia, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Received for publication July 25, 2006; accepted for publication August 8, 2006.

^_* Address for reprints: Pierre Bédard, MD, University of Ottawa Heart Institute, 40 Ruskin St, Suite H3205, Ottawa, Ontario K1Y 4W7, Canada. (Email: pbedard@ottawaheart.ca).

The first 20% of the full text of this article appears below.

Paravalvular leak (PVL) is a rare but serious complication of mitral valve replacement.^1,2 Although PVLs have traditionally been repaired surgically, there has been a growing interest in the attempt to close PVLs through the use of percutaneous interventional techniques with occluder devices.³ Herein we report an innovative and multidisciplinary approach to the repair of a severe mitral PVL in a patient with aortic and mitral mechanical prostheses. Interventional techniques were not successful, and the intraoperative exposure of the anterolateral mitral PVL was extremely difficult because of the presence of the aortic prosthesis. To our knowledge, this is the first reported case of an open surgical placement of a percutaneous occluder device to repair a mitral paraprosthetic leak.

Clinical Summary

A 58-year-old man presented with pulmonary edema and an apical pansystolic murmur. Seventeen years earlier, he had undergone aortic and mitral valve replacement with Medtronic-Hall prostheses (aortic prosthesis size 25; mitral prosthesis size 33; Medtronic Inc, Minneapolis, Minn) for rheumatic valve disease. Clinical and laboratory evaluation revealed no evidence of endocarditis or hemolysis. Echocardiography demonstrated mild left ventricular dysfunction and normally functioning aortic and mitral prostheses. However, there was a severe (4+) PVL . . . [Full Text of this Article]