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Chen, Lin, and Lu: Perioperative Detection of Paravalvular Leak After Sutureless Aortic Valve Replacement
Images in Cardiovascular Medicine

Korean Circulation Journal 2022; 52(11): 851-852.

Published online: 12 October 2022

DOI: https://doi.org/10.4070/kcj.2022.0196

Perioperative Detection of Paravalvular Leak After Sutureless Aortic Valve Replacement

Yan-Cheng Chen, MD1, *, Tzu-Yu Lin, PhD1, 2, Cheng-Wei Lu, PhD1, 2, *

1Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.

2Department of Mechanical Engineering, Yuan Ze University, Taoyuan City, Taiwan.

Correspondence to Yan Cheng Chen, MD. Department of Anesthesiology, Far Eastern Memorial Hospital, Number 21, Section 2, Nanya South Road, Banqiao District, New Taipei City, Taiwan. chenyancheng0904@gmail.com

*Yan-Cheng Chen and Cheng-Wei Lu contributed this article equally.

Received 20 July 2022       Revised 9 August 2022       Accepted 24 August 2022

Copyright © 2022. The Korean Society of Cardiology

The Korean Society of Cardiology

https://creativecommons.org/licenses/by-nc/4.0/
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
A 65-year-old woman presented to hospital with progressive exertional dyspnea. Transthoracic echocardiography (TTE) revealed severe aortic stenosis with estimated aortic valve area 0.85 cm2 (aortic valve annulus diameter: 23 mm). Minimally invasive cardiac surgery with sutureless aortic valve (perceval valve size M) replacement (SU-AVR) via right mini-parasternotomy was performed. After replacement, transesophageal echocardiography (TEE) revealed paravalvular leak (PVL) near the right coronary cusp (Figure 1A-C). Then, stent inversion was confirmed by surgeon (Figure 1D). After surgical revision by adjustment of the inverted stent (Figure 1E), no PVL was detected afterward. We had obtained informed consent from the patient.
SU-AVR is associated with improved hemodynamics when compared with conventional AVR.1) Rarely, the PVL of SU-AVR results from stent distortion due to oversizing or malposition of the implanted valve.2) TEE is a useful tool to confirm the diagnosis of PVL and multimodality imaging is essential to detect and quantify PVL.3) Careful investigation of postoperative TEE and TTE helped physicians to detect the possibility of PVL or other cardiac abnormalities.

Notes

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

Conflict of Interest: The authors have no financial conflicts of interest.

Data Sharing Statement: The data generated in this study is available from the corresponding author upon reasonable request.

Author Contributions:

  • Conceptualization: Chen YC, Lin TY, Lu CW.

  • Supervision: Lin TY, Lu CW.

  • Validation: Chen YC, Lu CW.

  • Visualization: Chen YC, Lu CW.

  • Writing - original draft: Chen YC.

  • Writing - review & editing: Chen YC, Lu CW.

References

1. Bilkhu R, Borger MA, Briffa NP, Jahangiri M. Sutureless aortic valve prostheses. Heart. 2019; 105:s16–s20. PMID: 30846520.
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2. Baert J, Astarci P, Noirhomme P, de Kerchove L. The risk of oversizing with sutureless bioprosthesis in small aortic annulus. J Thorac Cardiovasc Surg. 2017; 153:270–272. PMID: 27756462.
crossref
3. Bernard S, Yucel E. Paravalvular leaks-from diagnosis to management. Curr Treat Options Cardiovasc Med. 2019; 21:67. PMID: 31728667.
crossref
Figure 1

Arrow heads indicate distortion of a Perceval sutureless aortic valve stent (A). Aortic valve short axis view (B) and long axis view (C) showed PVL. Surgical images before revision (D) and after revision (E).

PVL = paravalvular leak.
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