Paravalvular leak (PVL) affects nearly 17% of patients following prosthetic valve replacements, particularly in the mitral position. While surgical revision is the standard of care, it carries significant risks for those with multiple previous sternotomies. Consequently, transcatheter PVL closure has emerged as a preferred, minimally invasive alternative for high-risk individuals. However, clinicians must remain vigilant regarding rare but severe complications such as device migration.

A recent case study involves a 37-year-old woman with mechanical mitral and aortic valves who developed heart failure from a mitral PVL. Initially, doctors achieved success using transcatheter PVL closure with two vascular plugs. Unfortunately, four months later, one plug migrated into the left ventricular outflow tract. This movement obstructed the mechanical aortic valve, leading to acute pulmonary edema. Furthermore, the patient’s clinical status made traditional surgery extremely hazardous.

Bailout Strategies in Transcatheter PVL Closure

Due to her prohibitive surgical risk, the medical team opted for a complex percutaneous retrieval. Specifically, they successfully extracted the embolized plug through the mechanical prosthesis. In addition, they performed an immediate re-closure of the PVL during the same session. This innovative approach restored hemodynamic stability and valve performance without requiring open-heart surgery. Therefore, this case underscores the importance of having advanced interventional skills available in specialized cardiac centers.

In conclusion, although device migration is uncommon, it remains a critical risk in transcatheter PVL closure. This report provides the first known instance of a successful percutaneous retrieval through a mechanical valve. Moreover, it demonstrates that advanced bailout strategies are feasible even in the most challenging anatomical settings. Physicians should consider these techniques when managing similar high-risk complications in clinical practice.

Frequently Asked Questions

What causes device migration after PVL closure?

Migration typically occurs due to undersizing of the device or the complex, irregular shape of the paravalvular defect. In addition, factors like suture dehiscence or lack of adequate tissue for anchoring can increase the risk of the plug becoming dislodged over time.

Is percutaneous retrieval safe for mechanical valve patients?

While extremely challenging, percutaneous retrieval is possible in expert hands. Specifically, it involves using snares or baskets to capture the device without damaging the mechanical leaflets. This method is generally reserved for patients who cannot survive a traditional surgical re-intervention.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Chaddad R et al. Prison Break: Extraction of a Plug Jailed Between Two Mechanical Valves. Catheter Cardiovasc Interv. 2026 Jun 10. doi: 10.1002/ccd.70686. PMID: 42271187.


2. Cruz-Gonzalez I, et al. Transcatheter closure of paravalvular leaks: state of the art. EuroIntervention. 2020;16(11):894-902.


3. Ruiz CE, et al. Clinical outcomes of transcatheter closure of perivalvular leaks. J Am Coll Cardiol. 2011;58(21):2210-2217.