After a heart valve replacement, a paravalvular leak may occur in the space between your heart tissue and new valve. This condition can often be treated with medication alone. When medications are not enough, Penn cardiologists correct paravalvular leaks with a nonsurgical, catheter-based procedure — saving patients from repeat heart surgery.
Through Penn’s designated Heart Valve Disease program, our interventional cardiologists repair even the most complex paravalvular leaks.
What Is a Paravalvular Leak (PVL) Closure?
Paravalvular leak, also called paravalvular regurgitation, refers to a leak caused by a space left between natural heart tissue and the valve replacement from a previous transcatheter aortic or mitral valve replacement. This condition most often affects the mitral valve, rather than the aortic valve.
Paravalvular leak closure is a nonsurgical procedure performed by an interventional cardiologist to repair these heart valve leaks. The procedure uses a closure device as a “plug” to block the source of the leak, guided to the appropriate valve through the femoral artery in the thigh.
Paravalvular leaks occur in up to 25 percent of patients following transcatheter aortic valve replacement (TAVR) and up to five percent of patients after surgical valve replacement.
When Is a PVL Closure Needed?
A paravalvular leak may initially present as a heart murmur or severe anemia (this is diagnosed through a blood test). If you have a larger leak, your condition may be accompanied by symptoms like that of heart failure and may require a PVL closure:
- Shortness of breath
- Unexpected and rapid weight gain
- Swelling in feet and legs
Your cardiologist may order tests to rule out infective endocarditis, an infection of your heart’s lining. The team at Penn Medicine uses specialized cardiovascular imaging techniques, such as echocardiography (echo) and transesophageal echocardiogram (TEE), to diagnose a paravalvular leak and determine the treatment plan.
Who Is a Good Candidate for Paravalvular Leak Closure?
Not all patients living with a PVL require the intervention of a paravalvular closure device. Additionally, not all patients are ideal candidates, meaning they may not be suitable for or benefit from this particular procedure. The criteria that physicians assess to determine candidacy for PVL closure include:
- Number of previous valve replacement surgeries
- Severity of backward blood flow caused by the valve leak
- Symptoms present that are associated with PVL, like shortness of breath
- Related conditions, including anemia and endocarditis
In addition to diagnostic testing, the cardiac team at Penn Medicine will gather information about your medical history and general health to determine the PVL treatment plan that fits your needs.
What to Expect from a Paravalvular Leak Closure
Paravalvular leak closure is a collaborative effort by a team of interventional cardiologists and imaging specialists. Together they diagnose the leak with advanced imaging procedures and use a catheter (long, thin tube) and a small plug to repair the leak.
Our interventional cardiologists perform paravalvular leak closures in a catheterization lab. You will be administered a general anesthetic to keep you comfortable. During the procedure, your cardiologist will:
- Insert a narrow, hollow catheter into the femoral artery or vein in your groin.
- Use advanced imaging techniques to guide the catheter to the area of your heart that contains the leak.
- Place a closure device (plug) on the leak.
- Remove the catheter from your blood vessel.
This procedure typically takes up to three hours to complete. Over time, your heart tissue will grow around the closure device and it will become part of your heart and its normal day to day function.
Benefits of a Catheter-Based PVL Closure
Paravalvular leaks were traditionally treated with additional heart surgery. As a nonsurgical procedure, catheter-based paravalvular leak closure offers many benefits, including:
- Immediate relief from symptoms associated with paravalvular leak
- Less invasive procedure with no incisions
- Low rates of complication
- Quick recovery and short hospital stay
Paravalvular Leak Closure Recovery and Rehabilitation
Penn Medicine cardiac team monitors your recovery closely. Immediately following the procedure, you will be moved from the operating room into a cardiac recovery room. Patients normally remain in the hospital overnight for observation and can go home the following day. You will be provided with aftercare instructions that discuss:
- Physical activity limitations
- Nutrition and diet recommendations, if needed
- Incision site cleaning and wound care
- Symptoms and pain management
- When to contact a doctor in the event of an emergency
Three months after the procedure, your cardiologist may conduct another TEE to assess the position of the closure device and any residual leaking.
Request an Appointment
To make an appointment, please call 800-789-7366 or request a callback.