Paravalvular Leak Assessment: Challenges in Assessing Severity and Interventional Approaches
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STRUCTURAL HEART DISEASE (RJ SIEGEL AND NC WUNDERLICH, SECTION EDITORS)
Paravalvular Leak Assessment: Challenges in Assessing Severity and Interventional Approaches Elias J. Fanous 1 & Roy B. Mukku 2 & Pranali Dave 3 & Olcay Aksoy 2 & Eric H. Yang 2 & Peyman Benharash 4 & Marcella Calfon Press 2 & Amir B. Rabbani 2 & Jamil A. Aboulhosn 5 & Asim M. Rafique 2 Accepted: 3 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review With increasing use of prosthetic valves to treat degenerative valvular heart disease (VHD) in an aging population, the incidence and adverse consequences of paravalvular leaks (PVL) are better recognized. The present work aims to provide a cohesive review of the available literature in order to better guide the evaluation and management of PVL. Recent Findings Despite gains in operator experience and design innovation, significant PVL remains a significant complication that may present with congestive heart failure and/or hemolytic anemia. To date, clear consensus or guidelines on the evaluation and management of PVL remain lacking. Summary Although the evolution of transcatheter valve therapies has had a tremendous impact on the management of patients with VHD, the limitations and complications of such techniques, including PVL, present further challenges. Incidence of PVL, graded as moderate or greater, ranges from 4 to 7.4% in surgical and transcatheter valve replacements, respectively. Improved imaging modalities and the advent of novel surgical and percutaneous therapies have undoubtedly yielded a better understanding of PVL including its anatomical location, mechanism, severity, and treatment options. Echocardiography, used in conjunction with cardiac computed tomography and cardiac magnetic resonance, provides essential details for diagnosis and management of PVL. Transcatheter intervention has become a favored approach in lieu of surgical intervention in select patients after previous surgical or percutaneous valve replacement. PVL treatment with vascular plugs, balloon post-dilation, and the valve-in-valve methods have shown technical success with promising clinical outcomes in appropriately selected patients. Keywords Paravalvular leak (PVL) . Bioprosthetic valve . Transcatheter aortic valve replacement (TAVR) . Vascular plug (VP) . Balloon post-dilation (BPD) . Valve-in-valve (ViV) This article is part of the Topical Collection on Structural Heart Disease * Asim M. Rafique [email protected]
Amir B. Rabbani [email protected]
Elias J. Fanous [email protected] Roy B. Mukku [email protected] Pranali Dave [email protected]
Jamil A. Aboulhosn [email protected] 1
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
2
Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Olcay Aksoy [email protected] 3
Eric H. Yang [email protected]
New York University, New York, NY, USA
4
Peyman Benharash pbenhar
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