Percutaneous endovascular devices have been used to close aorto‐pulmonary fistulas, aorto‐atrial fistulas, left ventricular pseudoaneurysms, 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 A and B). 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.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 leakThe procedure was performed in the cath lab under local anesthesia. The baseline central venous pressure (CVP) was 34 mmHg. Transthoracic echocardiography and fluoroscopy
Journal of Cardiac Surgery – Wiley
Published: Jan 1, 2018
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