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PROTHESIS VALVE DEFECT(PARAVALVULAR LEAK)

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Due to the Rheaumatic heart disease in adult or middle ages or because of degenerative valve or coronary artery disease in the elderly, a degenerative or structural distributive process begins in the heart valves and several patiens undergo to heart valve implantations by open heart surgery. These valves are generally implanted to the aortic or mitral position. After the open surgery, some holes can develop across the suture lines of the valve due to infection, degeneration, suture failure or other mechanisms. These holes are named as “paravalvular leak”. In this situation, heart failure or hemolysis can develop in the patient and many patients require a second open heart surgery. However, there is also much more risk of development of paravalvular leaks after the second operation. A redo open heart surgery carries a great risk and causes important complications. Thus, percutaneous transcatheter treatment of paravalvular leak by using some special devices contributes important comfort both to the patient and to the cardiologist.

Paravalvular leak develop in 8 to 18% of patients who underwent heart valve operations. Dyspnea episodes, symptoms of heart failure, anemia and icterus can develop due to the new regurgitation and hemolysis of erithrocytes at the hole. Paravalvular leaks can be classified as mitral and aortic paravalvular leaks.

MITRAL PARAVALVULAR LEAKS?
These defects are usually characterized as oval or cresentic defects. They are usually localized posteromedial edge of mitral bioprosthesis or mechanical prosthesis. Symptoms are generally related with the development of new mitral regurgitation. Heart failure or hemolysis can develop in the patient.

AORTIC PARAVALVULAR LEAKS?
These defects are usually characterized as long tunnel type or cylindirical type. They are usually localized lateral edges of aortic bioprosthesis or mechanical prosthesis. Symptoms are generally related with the development of new mitral regurgitation. Heart failure or hemolysis can develop in the patient.

In the past, the only treatment for paravalvular leak was redo-open heart surgery. However, we can close these defects by percutaneous transcatheter methods without open heart surgery.

HOW TO DIAGNOSE?
Echocardiography is an important diagnostic tool for the diagnosis of these defects. Transthorasic echocardiography makes a probable diagnosis but a definite diagnosis is made by transeusophageal echocardiography. After detection of colour Doppler jets across the valve by using 2D-TEE, real time 3D-TEE usually confirms the definite diagnosis. Three D TEE can also show us the location and number of the defect and can confirm us whether the defect can be closed without surgery or not. We are using 3D-TEE in our clinic in all patients with the suspicion of paravalvular leak.

How do we apply percutaneous transcatheter paravalvular leak closure?