Case report: paravalvular leak as a complication of percutaneous catheter ablation for atrial fibrillation
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CASE REPORT
Open Access
Case report: paravalvular leak as a complication of percutaneous catheter ablation for atrial fibrillation Orcun Gurbuz1*, Abdulkadir Ercan1, Hakan Ozkan2, Gencehan Kumtepe1, Ilker H Karal3 and Serdar Ener4
Abstract An increasing number of reports reveal the safety and efficacy of catheter ablation for atrial fibrillation therapy even in patients with a history of prosthetic heart valve. This case report presents a 60 year old female patient who had a prosthetic mitral paravalvular leak as a complication of radiofrequency ablation. Surgery revealed a 15 mm hole and three broken knots in the posterolateral mitral annulus. This report demonstrates radiofrequency ablation for atrial fibrillation in patients with prosthetic mitral valve may cause a paravalvular leak likely as a result of thermal injury. Moreover, patient can be asymptomatic at first. The clinician should keep in mind such complication and the patient should be evaluated in terms of paravalvular leakage. Keywords: Paravalvular leak, Percutaneous catheter ablation, Prosthetic heart valve
Background Since its first description in 1982 [1], radio frequency catheter ablation (RFA) has evolved to its present role as first-line therapy for most supraventricular arrhythmias [2-6]. The growing acceptance of this procedure has been brought about by an increasing number of reports revealing the safety and efficacy of catheter ablation for atrial fibrillation (AF) therapy. Reported complications of RFA include stroke, pericardial tamponade, valvular injury, pulmonary embolism, atrio-esophageal fistula and significant pulmonary vein (PV) stenosis [4-6]. We report the case of a patient with a history of mechanical mitral valve replacement (MVR) who had a paravalvular leak as a complication of RFA for AF therapy. This case is presented in order to draw attention to this rare presentation which has never been previously reported in the medical literature. Case presentation A sixty-year-old woman with the posterolateral prosthetic paravalvular leak (PVL) was referred to our clinic for surgical repair. She had a history of closed mitral * Correspondence: [email protected] 1 Department of Cardiovascular Surgery, Balikesir University, School of Medicine, Balikesir 10010, Turkey Full list of author information is available at the end of the article
commissurotomy 47 years ago, a prosthetic mitral valve replacement (MVR) in 1975 and a redo MVR in 2005 due valve dysfunction by pannus formation. Moreover, 1 years ago, she had undergone a pulmonary vein isolation (PVI), left atrium and mitral isthmus roof lines ablations for symptomatic persistent AF in another hospital, using CARTO mapping system (Biosense, Diamond Bar, CA, USA) and an irrigation ablation catheter (Biosense, ThermoCool? SF Catheter, USA). Furthermore, RFA was delivered at pulmonary veins for up to 30 W and at both lines up to 35 W with a temperature limitation of 50?C. Despite successful conversion to sinus rhythm she developed progressive cardiac failure in months. Third mont
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