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Mitral Valve Peravalvular (Periprosthetic) Leak

Mitral Valve Peravalvular (Periprosthetic) Leak. Incidence of Mitral Valve Peravalvular Leak. Reported frequency of 1.2-12.5% after mitral valve replacement Presenting symptoms 73.3% heart failure 16.2 % hemolysis 10.3%no symptoms Surgical results

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Mitral Valve Peravalvular (Periprosthetic) Leak

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  1. Mitral Valve Peravalvular (Periprosthetic) Leak

  2. Incidence of Mitral Valve Peravalvular Leak • Reported frequency of 1.2-12.5% after mitral valve replacement • Presenting symptoms • 73.3% heart failure • 16.2 % hemolysis • 10.3%no symptoms • Surgical results • 40-60% of peravalvular leaks could be repaired primarily without replacement of valve

  3.  Jacobs et al 1994 • 116 mitral valve surgeries (46 MV, 57 MV/CABG, 13 MV/AVR) • 8 patients with MV peravalvular regurgitation • 2/8 moderate • both progressed to severe at 18 months • 6/8 mild: • 2/6 increased from mild to moderate • one with CHF treated medically • other symptom free

  4. Jacobs et al 1994 • Conclusion: • Moderate peravalvular leak should be corrected at time of valve replacement if can be performed without high operative risk. • Mild peravalvular leak should probably also be corrected if low risk and surgeon believes high likelihood of success • Serial follow-up of peravalvular leak is important.

  5. Plehn et al 2001 • Found that people did well with trivial or mild peraprosthetic regurgitation.

  6. Risk factors for MV Peravalvular Leak • Strong • Endocarditis • Annular calcification •  Less Strong • Dilated cardiomyopathy. • Ischemic mitral regurgitation

  7.   Leak location • Pathologic: • in region of high calcification • in region of endocarditis/abscess •  Physiologic stress . • Found occurring more commonly in anterolateral and posteromedial portion of the mitral annulus

  8.  Echocardiographers role: • Define risk factors; annular calcium, infection • Search diligently for peravalvular leak post valve replacement. • Define location and severity.

  9. Case #1Mitral Valve Peravalvular Leak

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  11. Case #2Mitral Valve Peravalvular Leak • 78 yr old woman presenting with severe Mitral Regurgitation. • 5 years prior, patient declined recommendation for repair. • On following echoes note severe mitral annular calcification. • Surgeon notified of risk of peravalvular leak secondary to calcification.

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  16. Post Bypass • Status post placement bioprosthetic mitral valve • Note small peravalvular leak at anterior lateral portion of posterior mitral annulus • Note use of altering Nyquist to define location • Surgeon had optimized number and technique of annular stitches based on prebypass echo exam. Decision to accept surgical result.

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  23.  Reference: • Movsowitz, Jacobs et al: Long-term Follow-up of Mitral Paraprosthetic Regurgitation by Transesophageal Echocardiography. J Am Soc Echocardiogr 1994;488-92. • O'Rourke, Plehn et al: Outcome of Mild Periprosthetic Regurgitation Detected by Intraoperative Transesophageal Echocardiography. J Am Coll Cardiol 2001;38:163-6. • De Cicco, Lorusso: Mitral valve periprosthetic leakage: anatomical observations in 135 patients from a multicentre study. Europ J Cardio Thorac Surg: 30 (2006) 887-891. • Akins, MacGillivray: Early and Late Results of the Surgical Correction of Cardiac Prosthetic Paravavlular Leaks. J Heart Valve Dis 2005;14:792-800. • Dhasmana, Kirklin, Kouchoukos. Factors Associated With Periprosthetic Leakage Following Primary Mitral Valve Replacement: With Special Consideration of the Suture Technique

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