Case Report
Tabbah R, Rachoin R, Sawaya
Abstract
Background: Para-prosthetic leaks post valvular replacement is a relatively rare complication. Burden ofmortality and morbidity and recurrence increase with reoperation. Hemolysis is commonly seen in paravalvular leaks(PVL). Transcatheter repair is a less invasive technique with lower procedural mortality risk.Case presentation: A 59-year-old male patient, presented to his primary physician for dyspnea on exertion withno known previous medical history. Cardiac ultrasound revealed an aortic and mitral valve disease. A severelycalcified aortic valve with a moderately severe aortic regurgitation grade II to III and an aortic area of 1.3 cm2. Onthe other hand, a severely calcified mitral valve mainly the anterior leaflet and a severe mitral regurgitation grade IIIwith a mean gradient of 7 mmHg. Patient was sent for surgery. Two months after, patient presented with signs ofheart failure and hemolytic anemia. Transesophageal echocardiography (TEE) revealed a severe eccentricparavalvular mitral leak aiming to the left atrial appendage, with several paravalvular aortic leaks moderate to severeand a small ventricular septal defect. Transcatheter repair was done for the mitral paravalvular leak, 3 plugs wereneeded and yield excellent results, with one plug for the aortic paravalvular leak. Patient symptoms were better.Discussion: In this case, we illustrate the need for TEE with 3D TEE to have a more accurate diagnosis of postoperativecomplications. Always think about post-operative leaks in the setting of hemolytic anemia. Furthermore, awider use of the transcatheter techniques to reduce mortality and morbidity due to surgery.