IMAGES IN CARDIAC SURGERY
Percutaneous closure of tricuspid paravalvular leak
without contrast for a patient with renal insufficiency
Yang Liu PhD, MD
Shiqiang Yu PhD, MD
Lanlan Li MD
Xiaofeng Li MD
Jian Yang PhD, MD
Department of Cardiovascular Surgery, Xijing Hospital, Forth Military Medical University, Xi’an, China
Jian Yang PhD, MD, Department of Cardiovascular Surgery, Xijing Hospital, Forth Military Medical University, 127. Changle West Rd, Xi’an, China, 710032.
Science Development Project of Shaanxi Province, Grant number: 2016SF-225; The Distinguished Young Scholar Cultivation Project of Xijing Hospital,
Grant numbers: XJZT14J03, XJZT15ZL01; National Natural Science Foundation of China, Grant numbers: 81470500, 81500319
Percutaneous endovascular devices have been used to close aorto-
pulmonary fistulas, aorto-atrial fistulas, left ventricular pseudoaneur-
ysms, and prosthetic valvular leaks (PVL).
We present images of
a percutaneous closure of a PVL from a bioprosthetic tricuspid valve
in a patient with renal insufficiency without contrast.
A 76-year-old female presented with atrial fibrillation, renal
insufficiency, and progressive right heart failure, 12 years following
21-mm aortic, 25-mm mitral, and 31-mm tricuspid valve replacements
with Hancock bioprosthetic valves (Medtronic, Minneapolis, MN)
for rheumatic heart disease. A transthoracic echocardiogram
revealed a tricuspid bioprosthetic PVL near the ventricular septum
measuring 4 × 7 mm with an estimated regurgitant volume of 24 mL
(Figures 1A and 1B). The right ventricular ejection fraction was 37%
and the pulmonary artery pressure was 72/26 mmHg. In view of
her symptoms of right heart failure, severe renal insufficiency,
and increased operative risk, the patient underwent percutaneous
closure of the PVL without contrast medium.
The procedure was performed in the cath lab under local
anesthesia. The baseline central venous pressure (CVP) was
34 mmHg. Transthoracic echocardiography and fluoroscopy were
used to define the ring of the tricuspid bioprosthetic valve
which served as a landmark to locate the PVL. After obtaining
vascular access through the right femoral vein, a series of catheters
and wires were guided into the right atrium and postioned toward the
FIGURE 1 Pre-procedure transthoracic echocardiogram. (A) Sizing the PVL. (B) Measuring the regurgitation over PVL. The white arrow
indicates the PVL, while the colorful area indicates the regurgitation over the PVL. PVL, prosthetic valvular leak
© 2018 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/jocs J Card Surg. 2018;33:90–92.