• Narin Sriratanaviriyakul, Chari Hart, and Christian Spies.
• Department of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
• Catheter Cardiovasc Interv. 2011 Jul 1;78(1):145-50.

AbstractSevere paravalvular leakage following mitral valve replacement, a rare but potentially serious complication, may result in heart failure and significant hemolysis. Reoperation is considered standard of care. However, in selected patients, re-do sternotomy carries excessively high surgical risk. Percutaneous closure of paravalvular leaks has become a viable option for these patients. We present a case of a highly symptomatic 42-year-old male who underwent successful percutaneous closure of two paravalvular leaks and a post-operative atrial septal defect after re-do mitral valve replacement surgery. As access to the left atrium was expected to be difficult following percutaneous atrial septal defect closure, a two-step approach of paravalvular leak closure followed by atrial septal defect closure was chosen. Difficulties of atrial septal defect closure following closure of a paravalvular leak next to the inter-atrial septum will be discussed.Copyright © 2011 Wiley-Liss, Inc.

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