First application of the distal radial approach for severe mechanical surgical aortic valve paravalvular leak transcatheter closure with a double vascular plug: a case report

Viktor Sasi; Géza Fontos; Árpád Kormányos; Márton Vértesaljai; Zoltán Ruzsa

doi:10.1093/ehjcr/ytae366

First application of the distal radial approach for severe mechanical surgical aortic valve paravalvular leak transcatheter closure with a double vascular plug: a case report

Eur Heart J Case Rep. 2024 Jul 25;8(8):ytae366. doi: 10.1093/ehjcr/ytae366. eCollection 2024 Aug.

Authors

Viktor Sasi¹, Géza Fontos², Árpád Kormányos¹, Márton Vértesaljai², Zoltán Ruzsa¹

Affiliations

¹ Division of Invasive Cardiology, Department of Internal Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweiss str. 8, 6725 Szeged, Hungary.
² Gottsegen National Cardiovascular Center, Budapest, Hungary.

Abstract

Background: Severe aortic paravalvular leaks (PVLs) after surgical mechanical aortic valve replacement (AVR) represent a high risk for congestive heart failure, haemolysis, and infective endocarditis. This is the first reported case of distal radial artery (DRA) access for severe mechanical aortic PVL closure with a sequential double vascular plug guided by computed tomography angiography (CTA), transoesophageal echocardiography (TOE), and 3D TOE in an acute setting.

Case summary: A 51-year-old male presented with significant mixed aortic valve disease. Aortic valve replacement was performed (Slimline Bicarbon A-25 mm) according to guidelines. Four and 16 days later, a re-exploration was carried out due to pericardial effusion. Four months after discharge from rehabilitation, the patient was readmitted due to worsening dyspnoea on exertion and then at rest. Transthoracic echocardiography, TOE, and consequently, CTA, revealed severe PVL, following which the procedure of transcatheter PVL closure was chosen, with a preference for DRA access. After a CTA scan analysis and angiographic, TOE, and 3D TOE visualization of the leak, a 14/5 mm and a 10/5 mm vascular plug (AVPIII) were deployed to achieve good results. A 9-month clinical, echocardiographic, and CTA follow-up revealed good long-term results.

Discussion: For transcatheter PVL closure, CTA is helpful for not only vascular access planning, but also a visualization of the magnitude of the leak, location, and device planning. This case report demonstrates that the distal radial approach is feasible in patients with severe mechanical aortic valve PVL retrograde transcatheter closure. DRA access could possibly represent less bleeding and vascular access site complications when compared with femoral access and has some potential advantages over regular radial access.

Keywords: Aortic paravalvular leak; Case report; Distal radial approach; Surgical aortic valve replacement; Transcatheter paravalvular leak closure; Vascular plug.

Publication types

Case Reports