Paravalvular Leak

Over time, leaks can develop around mechanical (an artificial valve used to replace a damaged heart valve, usually made out of titanium or carbon) or bioprosthetic (an artificial heart valve made out of animal tissue, usually from a pig) replacement valves. These leaks can occur around aortic, mitral, pulmonary or tricuspid valves that have been replaced.

What is a Paravalvular Leak?

After a while, a space may develop between the outer ring of the replacement valve and your normal tissue. That space allows blood to leak out, rather than going through the valve. You are at risk for a paravalvular leak if you have:

  • Had the same valve replaced multiple times
  • Had an infection that affects the heart, such as endocarditis
  • Developed severe calcium deposits on the ring around the replacement valve (the annulus)

Symptoms of Paravalvular Leak

The symptoms of paravalvular leaks are similar to the symptoms of valve regurgitation in your own valve and of heart failure. Symptoms may include:

  • Fatigue
  • Chest pain (angina), pressure or discomfort
  • Shortness of breath (dyspnea)
  • Swelling in your legs, ankles or feet (edema)
  • Swelling in your belly or abdomen (ascites)
  • Feeling faint (syncope)
  • Unexplained weight gain
  • Low red blood cell count (anemia)
  • Dark urine

Diagnosing Paravalvular Leak

Contact your doctor if you have had a valve replacement procedure and you experience any of the symptoms of paravalvular leak. Your doctor will discuss your medical history and your symptoms, and conduct a physical examination. Your doctor may also order one or more specialized tests, such as:

  • Computed tomography scan (CT scan). This imaging technology uses a computer to combine a series of X-ray images from different angles to create an image that shows a slice or cross-section of a portion of the body. Also known as CAT scan.
  • Echocardiogram (Echo). This test uses ultrasound to create an image of the heart. The ultrasound waves bounce or “echo” off the heart to show the size, shape and movement of the heart’s chambers and valves, and also the blood flow. The ultrasound waves are created by a machine called a transducer. The transducer can be placed on your skin or very small transducer can be inserted into your esophagus.
  • Transesophageal echocardiogram (TEE). This advanced heart imaging technology uses a very small transducer positioned in the esophagus to produce images of the heart that are not obstructed by skin, muscle or bones.

    Significant paravalvular leak around a bioprosthetic aortic valve

  • MRI (magnetic resonance imaging). This imaging technology uses a magnetic field and radio waves to create images of organs and tissues inside the body.

Depending on your examination and test results, your doctor may recommend careful monitoring for a while, or refer you to the specialists at the Structural Heart and Valve Disease program at the Swedish Heart & Vascular Institute in Seattle.

Treating Paravalvular Leak

The Structural Heart and Valve Disease team at Swedish evaluates patients with paravalvular leaks for the most appropriate treatment. Options may include open-heart surgery, minimally invasive surgery or a catheter-based procedure.

A percutaneous (through the skin) paravalvular leak closure is a catheter-based procedure that may provide significant symptom relief and prolong survival for patients who are too ill and cannot tolerate open-heart surgery. Your cardiologist will use 3-D imaging (echocardiography) and CT imaging before, during and after the procedure to ensure the closure device is precisely positioned and works properly.

Closure of an aortic paravalvular leak, with arrow pointing to the closure device.

Your anesthesiologist will use a combination of local anesthetic, conscious (twilight) sedation and general anesthesia to minimize pain, and to ensure you are relaxed and not anxious. The cardiologist will thread a tiny catheter through a small incision in your groin, and then through femoral artery (a large artery in your thigh that supplies oxygen-rich blood to your leg) or vein to the heart. In some cases, the cardiologist will make a small incision in the side of the chest to deliver the catheter to the valve. The cardiologist uses the catheter to deliver the closure device and to position it around the leak.