Dear Editor,

We read the article entitled ‘Transcatheter closure through transapical access for mitral paravalvular leak after previous trans-septal mitral operation’ [1]. The authors noted that transapical approach for transcatheter paravalvular leak closure (PVLC) may an alternative technique for transcatheter paravalvular leak (PV) closure in the case of transseptal approach is not available, and they also reported that this is the first case report of transapical access for transcatheter PVC in Japan. There has been a growing interest in less invasive procedures, so catheter-based closure of a PV is a possible alternative to the surgical closure. A number of case series have been reported with encouraging success rates and good results [2–4].

There are new apical closure devices for closure of percutaneous apical accesses. We also reported previously two cases of successful percutaneous closure of the apical access with ADO-II devices after a standard transapical mitral PVLC procedure obtaining percutaneous puncture with a needle at the fifth intercostal space without minithoracotomy from Turkey [5, 6]. The conventional coronary angiogram (CAG) or computed tomography-guided CAG may be very useful to obtain optimal puncture of cardiac apex in order not to damage left anterior descending artery. The authors might consider percutaneous closure of the apical access with a device after a standard transapical mitral PVLC with a needle without minithoracotomy. Percutaneous apical closure of cardiac apex would be useful for the patients with high surgery risk as less invasive therapy.