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Paravalvular Leak Immediately Following Repeat Mitral Valve Replacement: Considerations for Repair in a High-Risk Patient

      A PARAVALVULAR LEAK (PVL) immediately after mitral valve replacement (MVR) surgery is a well-known and dreaded complication shown to affect 2% to 30% of patients. The patients with a PVL often suffer debilitating congestive heart failure symptoms resulting from retrograde blood flow and hemolytic anemia from the shearing injury caused by high velocity jets.

      Genoni M, Franzen D, Tavakoli R, et al. Does the morphology of mitral paravalvular leaks influence symptoms and hemolysis? J Heart Valve Dis 2001;10:426-30.

      As a result, these patients are more likely to require repeated blood product transfusions, reoperation, and have an increased risk of mortality.
      • Hwang HY
      • Choi JW
      • Kim HK
      • et al.
      Paravalvular leak after mitral valve replacement: 20 year follow-up.
      • Ionescu A
      • Fraser AG
      • Butchart EG.
      Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: A prospective study using transoesophageal echocardiography.
      • Cho IJ
      • Moon J
      • Shim CY
      • et al.
      Different clinical outcome of paravalvular leakage after aortic or mitral valve replacement.
      Risk factors for PVL include advanced age, a small body surface area, preoperative infective endocarditis, annular calcification, redo valve surgery, annular reconstruction, the use of a bioprosthetic instead of mechanical valve, and the use of continuous instead of intermittent sutures.
      • Hwang HY
      • Choi JW
      • Kim HK
      • et al.
      Paravalvular leak after mitral valve replacement: 20 year follow-up.
      ,
      • Ionescu A
      • Fraser AG
      • Butchart EG.
      Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: A prospective study using transoesophageal echocardiography.
      ,
      • Zoghbi WA
      • Chambers JB
      • Dumesnil JG
      • et al.
      Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: A report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography.
      ,
      • O'Rourke DJ
      • Palac RT
      • Malenka DJ
      • et al.
      Outcome of mild periprosthetic regurgitation detected by intraoperative transesophageal echocardiography.

      Key Words

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