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Paravalvular Leak Assessment: Challenges in Assessing Severity and Interventional Approaches

Current Cardiology Reports volume 22, Article number: 166 (2020) Cite this article

Abstract

Purpose of Review

With increasing use of prosthetic valves to treat degenerative valvular heart disease (VHD) in an aging population, the incidence and adverse consequences of paravalvular leaks (PVL) are better recognized. The present work aims to provide a cohesive review of the available literature in order to better guide the evaluation and management of PVL.

Recent Findings

Despite gains in operator experience and design innovation, significant PVL remains a significant complication that may present with congestive heart failure and/or hemolytic anemia. To date, clear consensus or guidelines on the evaluation and management of PVL remain lacking.

Summary

Although the evolution of transcatheter valve therapies has had a tremendous impact on the management of patients with VHD, the limitations and complications of such techniques, including PVL, present further challenges. Incidence of PVL, graded as moderate or greater, ranges from 4 to 7.4% in surgical and transcatheter valve replacements, respectively. Improved imaging modalities and the advent of novel surgical and percutaneous therapies have undoubtedly yielded a better understanding of PVL including its anatomical location, mechanism, severity, and treatment options. Echocardiography, used in conjunction with cardiac computed tomography and cardiac magnetic resonance, provides essential details for diagnosis and management of PVL. Transcatheter intervention has become a favored approach in lieu of surgical intervention in select patients after previous surgical or percutaneous valve replacement. PVL treatment with vascular plugs, balloon post-dilation, and the valve-in-valve methods have shown technical success with promising clinical outcomes in appropriately selected patients.

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Author information

Affiliations

  1. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Elias J. Fanous

  2. Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Roy B. Mukku, Olcay Aksoy, Eric H. Yang, Marcella Calfon Press, Amir B. Rabbani & Asim M. Rafique

  3. New York University, New York, NY, USA

    Pranali Dave

  4. Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Peyman Benharash

  5. Ahmanson/UCLA Adult Congenital Heart Center Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Jamil A. Aboulhosn

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  1. Elias J. Fanous
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  2. Roy B. Mukku
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  4. Olcay Aksoy
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Correspondence to Asim M. Rafique.

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Conflict of Interest

Jamil A. Aboulhosn reports receiving research support from, and being a proctor and a consultant for, Edwards Lifesciences; and being a consultant for Medtronic Inc.

All of the other authors have no conflicts of interest.

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Fanous, E.J., Mukku, R.B., Dave, P. et al. Paravalvular Leak Assessment: Challenges in Assessing Severity and Interventional Approaches. Curr Cardiol Rep 22, 166 (2020). https://doi.org/10.1007/s11886-020-01418-7

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  • DOI: https://doi.org/10.1007/s11886-020-01418-7

Keywords

  • Paravalvular leak (PVL)
  • Bioprosthetic valve
  • Transcatheter aortic valve replacement (TAVR)
  • Vascular plug (VP)
  • Balloon post-dilation (BPD)
  • Valve-in-valve (ViV)