Objective: To evaluate the efficacy of transcatheter intervention of paravalvular leakage (PVL) after mitral valve replacement.
Methods: Present respective study included 15 patients (8 males and mean age (53.5±11.7) years) with mitral PVL who underwent interventional therapy in our hospital from April 2014 to May 2015. There were 9 cases with NYHA heart function Ⅲ, 6 cases with NYHA heart function Ⅳ. Left ventricular ejection fraction was (46.8±8.2)%, and mitral regurgitation volume was 12.0 (10.0, 15.0)ml before the intervention. Transcatheter intervention was carried out in the catheterization laboratory or the hybrid operation room with initial local anesthesia. By puncturing femoral artery and implantation of different congenital heart disease devices, the mitral PVL were occluded interventionally. To some complicated cases, the occluder was implanted by puncturing apex and atrial septum. Follow-up evaluation included peri-operational mortality, complications and postoperative residual shunt.
Results: The median time between transcatheter intervention and previous operation was 5.0 (0.6, 7.0) years. One patient did not tolerate the operation and occlude was not implanted in this patient. The success rate of transcatheter intervention was 93.3% (14/15). The average operation time was (126.7±56.4)min, and X ray exposure time was (21.0±10.0)min, and median hospitalization time was 7.0 (6.0, 10.0)d. The main post-operative complications included 1 case of hemoptysis, 1 case of acute renal failure, 1 case of hematuria and 4 cases of blood transfusion. The median follow-up time was 7.0 (4.0, 12.0) months. During the follow-up, there was no death and no serious complications. One month after the procedure, left ventricular ejection fraction significantly increased to(52.1±4.3)%, and median mitral regurgitation significantly reduced to 0.5 (0, 2.0)ml (all P<0.05).
Conclusion: The interventional therapy for PVL after mitral valve replacement is safe and effective, and further studies are warranted to observe the long-term effect of this procedure.