Percutaneous Transapical Closure of Severe Paravalvular Mitral Regurgitation

A 42-year-old female with a history of endocarditis requiring bioprosthetic aortic and mitral valve replacements presented with progressive shortness of breath and severe paravalvular regurgitation abutting the bioprosthetic mitral valve. A percutaneous transapical approach, guided by fluoroscopy and echocardiography, allowed crossing of the defect with confirmation of the wire on TEE. Catheter and wire exchanges were performed before advancing a 6 Fr delivery system over a supportive wire across the defect and into the left atrium. Based on TEE sizing, a 6-mm Amplatzer muscular VSD occluder device was successful deployed across the defect with fluoroscopic and TEE guidance confirming appropriate exclusion of regurgitant flow. Finally, the delivery system was retracted into the mid LV cavity at which point a 6/4-mm Amplatzer duct occluder was deployed in the LV apex with a final LV angiogram revealing no residual ventricular defect.

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All Authors: Rajeev K. Anchon, MD and Atman P. Shah, MD.

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