Transcatheter Closure of Mitral Paravalvular Leak via Multiple Approaches

Figure 5

Closure of a mitral paravalvular leak (PVL) via the transapical approach. (a–d) The transcatheter closure of the mitral PVL via a minimally invasive transapical approach. (a) The transapical accesses were obtained by placement of a 6 Fr sheath. (b) The mitral PVL was crossed retrogradely. (c) The introducer sheath was advanced into the left atrium. (d) The occluder was deployed. (e–h) Transcatheter closure of the mitral PVL via a transapical puncture and arteriovenous loop. (e) Coronary angiogram to confirm the location of the left anterior descending artery. (f) A 5 Fr sheath was placed into the left ventricle percutaneously. (g) The transseptal puncture was followed by snaring the wire to establish an arteriovenous loop. (h) The occluder was placed at the position of the PVL followed by a left ventricular angiogram. The black arrow indicates the PVL. The white arrow indicates the occluder.

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)