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Management Strategies of Paravalvular Leak in the Post-Transcatheter Aortic Valve Replacement Patient
Journal article   Open access   Peer reviewed

Management Strategies of Paravalvular Leak in the Post-Transcatheter Aortic Valve Replacement Patient

Mariah Mascara, Ben Boyarko, Adnan Khalif, David Lasorda and Ramzi Khalil
JACC. Case reports, v 30(20), 104189
23 Jul 2025
DOI: https://doi.org/10.1016/j.jaccas.2025.104189
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https://doi.org/10.1016/j.jaccas.2025.104189View
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Abstract

balloon postdilatation paravalvular leak TAVR vascular plug
An 82-year-old man with prior transcatheter aortic valve replacement (TAVR) with an Edwards Sapien valve presented 30 months later with worsening anemia and mild dyspnea. Laboratory test results indicated hemolysis, and transthoracic echocardiography revealed moderate-to-severe aortic paravalvular leak (PVL) with a 2.3-mm perivalvular gap. The patient underwent PVL closure with an 8-mm vascular plug, followed by balloon valvuloplasty with a 24-mm True balloon, resulting in complete PVL resolution. The patient remained symptom free after the procedure, with no recurrence of anemia or heart failure. This case highlights the diagnosis and dual treatment approach for PVL-induced hemolysis after TAVR, using percutaneous closure with a vascular plug and balloon valvuloplasty. When managing post-TAVR PVLs, incorporating both vascular plugs and balloon postdilatation may improve patient outcomes in select scenarios, such as complex PVLs, challenging anatomy, or failure of previous PVL repair. [Display omitted]

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