Coil Embolization of a Periprosthetic Mitral Valve Leak Associated With Severe Hemolytic Anemia
2001; Lippincott Williams & Wilkins; Volume: 104; Issue: 16 Linguagem: Inglês
10.1161/hc4101.096829
ISSN1524-4539
AutoresMauro Moscucci, G. Michael Deeb, David S. Bach, Kim A. Eagle, David M. Williams,
Tópico(s)Cardiac Valve Diseases and Treatments
ResumoHomeCirculationVol. 104, No. 16Coil Embolization of a Periprosthetic Mitral Valve Leak Associated With Severe Hemolytic Anemia Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBCoil Embolization of a Periprosthetic Mitral Valve Leak Associated With Severe Hemolytic Anemia Mauro Moscucci, MD, G. Michael Deeb, MD, David Bach, MD, Kim A. Eagle, MD and David M. Williams, MD Mauro MoscucciMauro Moscucci From the Division of Cardiology, Department of Internal Medicine (M.M., D.B., K.A.E.); Division of Cardiac Surgery, Department of Surgery (G.M.D.); and the Department of Radiology (D.M.W.), University of Michigan Health System, Ann Arbor. , G. Michael DeebG. Michael Deeb From the Division of Cardiology, Department of Internal Medicine (M.M., D.B., K.A.E.); Division of Cardiac Surgery, Department of Surgery (G.M.D.); and the Department of Radiology (D.M.W.), University of Michigan Health System, Ann Arbor. , David BachDavid Bach From the Division of Cardiology, Department of Internal Medicine (M.M., D.B., K.A.E.); Division of Cardiac Surgery, Department of Surgery (G.M.D.); and the Department of Radiology (D.M.W.), University of Michigan Health System, Ann Arbor. , Kim A. EagleKim A. Eagle From the Division of Cardiology, Department of Internal Medicine (M.M., D.B., K.A.E.); Division of Cardiac Surgery, Department of Surgery (G.M.D.); and the Department of Radiology (D.M.W.), University of Michigan Health System, Ann Arbor. and David M. WilliamsDavid M. Williams From the Division of Cardiology, Department of Internal Medicine (M.M., D.B., K.A.E.); Division of Cardiac Surgery, Department of Surgery (G.M.D.); and the Department of Radiology (D.M.W.), University of Michigan Health System, Ann Arbor. Originally published16 Oct 2001https://doi.org/10.1161/hc4101.096829Circulation. 2001;104:e85–e8655-year-old man presented with severe fatigue, anorexia, and weight loss. His past medical history was significant for diabetes mellitus, severe mitral annulus calcification, aortic and mitral valve replacement, prosthetic mitral valve endocarditis complicated by periprosthetic mitral regurgitation, and repeat mitral valve replacement 2 months before admission.Admission hemoglobin was 6 g/dL and additional laboratory evaluation was consistent with severe hemolytic anemia. A transesophageal echocardiogram (TEE) revealed a periprosthetic mitral valve leak that we believed to be the cause of the hemolytic anemia (Figure 1). During initial hospitalization, the patient remained transfusion dependent. Download figureDownload PowerPointFigure 1. Transesophageal images obtained before deploying the coils. A, The arrow indicates the area corresponding to the leak across the sewing ring. LA indicates left atrium; LAA, left atrial appendage. B, Regurgitant flow across the leak.In view of his past history, we did not believe the patient to be a candidate for a third mitral valve replacement. Therefore, we decided to attempt coil embolization of the periprosthetic leak.Using the transseptal approach, we crossed the perivalvular leak with a guidewire under TEE and fluoroscopic guidance (Figure 2). A 4F glide vertebral catheter (Boston Scientific) was then advanced over the wire into the ventricular apex. Using the 4F catheter, two 9-cm-long retrievable dumbbell coils, 5 mm diameter on each end and 2 mm diameter in the middle, were deployed across the leak. Postdeployment films demonstrated symmetric deployment of the coils across the mitral ring with approximately one half on either side (Figure 3). Download figureDownload PowerPointFigure 2. Right anterior oblique view of the prosthetic mitral valve. The glide wire has been advanced into the left ventricle across the mitral valve leak. The TEE probe can be seen in the top portion of the figure.Download figureDownload PowerPointFigure 3. A and B show radiographic images after deploying the coils. Both coils have been symmetrically deployed across the mitral valve ring.The patient's hemoglobin stabilized after the procedure, and his serum lactic dehydrogenase level decreased from a baseline of ≈4000 IU/L to ≈1400 IU/L. This was associated with a dramatic decrease in transfusion requirement (Figure 4). The international normalized ratio was maintained between 2 and 2.5, and the patient was discharged to his home in stable condition 5 days after the procedure. After discharge, his hemoglobin continued to remain stable, and at 9-month follow-up, there were no complications related to the procedure. Download figureDownload PowerPointFigure 4. Transfusion requirement before deployment of the coils and during follow-up. Day 0 is the day of successful deployment of the coils. The y axis indicates number of units of packed red blood cells transfused.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.FootnotesCorrespondence to David M. Williams, MD, Department of Radiology, Rm B1d530a/0030, University of Michigan Medical Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited BySingh M, Gulati R, Lewis B, Zhou Z, Alkhouli M, Friedman P and Bell M (2022) Multimorbidity and Mortality Models to Predict Complications Following Percutaneous Coronary Interventions, Circulation: Cardiovascular Interventions, 15:7, (e011540), Online publication date: 1-Jul-2022. Gössl M (2022) Transcatheter closure of periprosthetic leaks, Progress in Cardiovascular Diseases, 10.1016/j.pcad.2022.06.006, Online publication date: 1-Jun-2022. Hahn R (2019) Echocardiography in Percutaneous Valvular Intervention Essential Echocardiography, 10.1016/B978-0-323-39226-6.00032-1, (323-346.e3), . Venturini J, Rosenberg J, Lang R and Shah A (2017) Transapical Access for Percutaneous Mitral Paravalvular Leak Repair, Structural Heart, 10.1080/24748706.2017.1353188, 1:3-4, (121-128), Online publication date: 1-Mar-2017. Hahn R (2016) Transcathether Valve Replacement and Valve Repair, Circulation Research, 119:2, (341-356), Online publication date: 8-Jul-2016. Hahn R (2016) Transcatheter Closure of Paravalvular Regurgitation: Case-Based Learning Intraprocedural Imaging of Cardiovascular Interventions, 10.1007/978-3-319-29428-5_7, (83-89), . Quader N, Davidson C and Rigolin V (2015) Percutaneous Closure of Perivalvular Mitral Regurgitation: How Should the Interventionalists and the Echocardiographers Communicate?, Journal of the American Society of Echocardiography, 10.1016/j.echo.2015.02.004, 28:5, (497-508), Online publication date: 1-May-2015. Cruz-Gonzalez I, Rama-Merchan J, Arribas-Jimenez A, Rodriguez-Collado J, Martin-Moreiras J, Cascon-Bueno M and Luengo C (2014) Cierre percutáneo de fugas periprotésicas con el dispositivo Amplatzer Vascular Plug III: resultados inmediatos y a corto plazo, Revista Española de Cardiología, 10.1016/j.recesp.2013.09.033, 67:8, (608-614), Online publication date: 1-Aug-2014. Cruz-Gonzalez I, Rama-Merchan J, Arribas-Jimenez A, Rodriguez-Collado J, Martin-Moreiras J, Cascon-Bueno M and Luengo C (2014) Paravalvular Leak Closure With the Amplatzer Vascular Plug III Device: Immediate and Short-term Results, Revista Española de Cardiología (English Edition), 10.1016/j.rec.2013.09.031, 67:8, (608-614), Online publication date: 1-Aug-2014. Nishimura R, Otto C, Bonow R, Carabello B, Erwin J, Guyton R, O'Gara P, Ruiz C, Skubas N, Sorajja P, Sundt T, Thomas J, Anderson J, Halperin J, Albert N, Bozkurt B, Brindis R, Creager M, Curtis L, DeMets D, Guyton R, Hochman J, Kovacs R, Ohman E, Pressler S, Sellke F, Shen W, Stevenson W and Yancy C (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease, The Journal of Thoracic and Cardiovascular Surgery, 10.1016/j.jtcvs.2014.05.014, 148:1, (e1-e132), Online publication date: 1-Jul-2014. Nishimura R, Otto C, Bonow R, Carabello B, Erwin J, Guyton R, O'Gara P, Ruiz C, Skubas N, Sorajja P, Sundt T and Thomas J (2014) 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease, Circulation, 129:23, (e521-e643), Online publication date: 10-Jun-2014. Nishimura R, Otto C, Bonow R, Carabello B, Erwin J, Guyton R, O'Gara P, Ruiz C, Skubas N, Sorajja P, Sundt T and Thomas J (2014) 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease, Journal of the American College of Cardiology, 10.1016/j.jacc.2014.02.536, 63:22, (e57-e185), Online publication date: 1-Jun-2014. Sorajja P, Cabalka A, Hagler D and Rihal C (2014) The Learning Curve in Percutaneous Repair of Paravalvular Prosthetic Regurgitation, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2014.01.159, 7:5, (521-529), Online publication date: 1-May-2014. Gössl M and Rihal C (2013) Percutaneous Treatment of Aortic and Mitral Valve Paravalvular Regurgitation, Current Cardiology Reports, 10.1007/s11886-013-0388-9, 15:8, Online publication date: 1-Aug-2013. Heo Y, Kim S, Lee S and Baek J (2013) A Case Demonstrating a Percutaneous Closure Using the Amplatzer Duct Occluder for Paravalvular Leakage after Tricuspid Valve Replacement, Korean Circulation Journal, 10.4070/kcj.2013.43.4.273, 43:4, (273), . Thourani V, Smith C, Guyton R, Block P, Liff D, Willis P, Lerakis S, Arepalli C, Howell S, Boulton B, Stewart J and Babaliaros V (2012) Repair of Prosthetic Mitral Valve Paravalvular Leak Using an Off-Pump Transapical Approach, The Annals of Thoracic Surgery, 10.1016/j.athoracsur.2011.12.035, 94:1, (275-278), Online publication date: 1-Jul-2012. Branny M, Januška J, Škňouřil L, Holek B, Dorda M and Gajdůšek L (2012) Management of paravalvular leaks, Cor et Vasa, 10.1016/j.crvasa.2012.05.013, 54:5-6, (e151-e155), Online publication date: 1-May-2012. Rihal C, Sorajja P, Booker J, Hagler D and Cabalka A (2012) Principles of Percutaneous Paravalvular Leak Closure, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2011.11.007, 5:2, (121-130), Online publication date: 1-Feb-2012. Sorajja P, Cabalka A, Hagler D and Rihal C (2011) Percutaneous Repair of Paravalvular Prosthetic Regurgitation, Circulation: Cardiovascular Interventions, 4:4, (314-321), Online publication date: 1-Aug-2011. García E, Hernández-Antolín R, Dutary J, Paulo M, Heredia J, Guerrero F, Rodríguez J, Gorgadze T and Macaya C (2011) Rapidly Evolving Techniques for Structural Heart Disease Interventions, Revista Española de Cardiología, 10.1016/j.recesp.2011.05.032, 64, (19-27), Online publication date: 1-Jul-2011. García Fernández M, de Diego J, Pérez David E, García Robles J and García Fernández E (2011) Transesophageal Echocardiography Dynamic Echocardiography, 10.1016/B978-1-4377-2262-8.00104-3, (433-436), . Huang C, Yitzhaki S, Perry C, Liu W, Giricz Z, Mentzer R and Gottlieb R (2010) Autophagy Induced by Ischemic Preconditioning is Essential for Cardioprotection, Journal of Cardiovascular Translational Research, 10.1007/s12265-010-9189-3, 3:4, (365-373), Online publication date: 1-Aug-2010. Nietlispach F, Johnson M, Moss R, Wijesinghe N, Gurvitch R, Tay E, Thompson C and Webb J (2010) Transcatheter Closure of Paravalvular Defects Using a Purpose-Specific Occluder, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2010.04.013, 3:7, (759-765), Online publication date: 1-Jul-2010. Biner S, Kar S, Siegel R, Rafique A and Shiota T (2010) Value of Color Doppler Three-Dimensional Transesophageal Echocardiography in the Percutaneous Closure of Mitral Prosthesis Paravalvular Leak, The American Journal of Cardiology, 10.1016/j.amjcard.2009.11.022, 105:7, (984-989), Online publication date: 1-Apr-2010. Fernandez M, Perk G, Saric M and Kronzon I (2010) Real Time Three Dimensional Transesophageal Echocardiography for Guidance of Catheter Based Interventions Textbook of Real-Time Three Dimensional Echocardiography, 10.1007/978-1-84996-495-1_12, (121-133), . SINGH G, ROHILLA A, SINGH M and BALAKUMAR P (2009) Possible Role of JAK-2 in Attenuated Cardioprotective Effect of Ischemic Preconditioning in Hyperhomocysteinemic Rat Hearts, YAKUGAKU ZASSHI, 10.1248/yakushi.129.523, 129:5, (523-535), Online publication date: 1-May-2009. Shapira Y, Vaturi M and Sagie A (2009) Hemolysis Associated With Prosthetic Heart Valves, Cardiology in Review, 10.1097/CRD.0b013e31819f1a83, 17:3, (121-124), Online publication date: 1-May-2009. García-Borbolla Fernández R, Sancho Jaldón M, Calle Pérez G, Gómez Menchero A, de Zayas Rueda R, Arana Granado R, Marante Fuertes E and Cabeza Laínez P (2009) Percutaneous Treatment of Mitral Valve Periprosthetic Leakage. An Alternative to High-Risk Surgery?, Revista Española de Cardiología (English Edition), 10.1016/S1885-5857(09)71671-8, 62:4, (438-441), Online publication date: 1-Apr-2009. García-Borbolla Fernández R, Sancho Jaldón M, Calle Pérez G, Gómez Menchero A, de Zayas Rueda R, Arana Granado R, Marante Fuertes E and Cabeza Laínez P (2009) Cierre percutáneo de las dehiscencias periprotésicas mitrales. ¿La alternativa a una cirugía de alto riesgo?, Revista Española de Cardiología, 10.1016/S0300-8932(09)70901-7, 62:4, (438-441), Online publication date: 1-Apr-2009. Kim M, Casserly I, Garcia J, Klein A, Salcedo E and Carroll J (2009) Percutaneous Transcatheter Closure of Prosthetic Mitral Paravalvular Leaks, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2008.10.012, 2:2, (81-90), Online publication date: 1-Feb-2009. Franke J, Steinberg D and Sievert H (2009) Interventional treatment of structural heart disease, Minimally Invasive Therapy & Allied Technologies, 10.1080/13645700902920486, 18:3, (110-121), Online publication date: 1-Jan-2009. SLIM A, SANGHI P, SHRY E, CASTILLO-ROJAS L, ALVAREZ J, HERNANDEZ A, CONNER W, ERIKSON J and BAILEY S (2008) Transcatheter Cardiac Fistula Repair with the Amplatzer Duct Occluder: A Case Report and Review, Journal of Interventional Cardiology, 10.1111/j.1540-8183.2007.00325.x, 21:3, (260-264), Online publication date: 1-Jun-2008. LASORDA D and MOHSIN J (2008) Percutaneous Closure of Perivalvular Mitral Regurgitation with an Amplatzer Occluder Device in a Patient with Both Prosthetic Mitral and Aortic Valves, Journal of Interventional Cardiology, 10.1111/j.1540-8183.2007.00343.x, 21:2, (190-195), Online publication date: 1-Apr-2008. Cortés M, García E, García-Fernandez M, Gomez J, Perez-David E and Fernández-Avilés F (2008) Usefulness of Transesophageal Echocardiography in Percutaneous Transcatheter Repairs of Paravalvular Mitral Regurgitation, The American Journal of Cardiology, 10.1016/j.amjcard.2007.08.052, 101:3, (382-386), Online publication date: 1-Feb-2008. Kort H, Sharkey A and Balzer D (2004) Novel use of the Amplatzer duct occluder to close perivalvar leak involving a prosthetic mitral valve, Catheterization and Cardiovascular Interventions, 10.1002/ccd.10785, 61:4, (548-551), Online publication date: 1-Apr-2004. Moe M, Berg-Johnsen J, Larsen G, Kampenhaug E and Vinje M (2003) The Effect of Isoflurane and Sevoflurane on Cerebrocortical Presynaptic Ca2+ and Protein Kinase C Activity, Journal of Neurosurgical Anesthesiology, 10.1097/00008506-200307000-00008, 15:3, (209-214), Online publication date: 1-Jul-2003. Asano G, Asano G, Takashi E, Ishiwata T, Onda M, Yokoyama M, Naito Z, Ashraf M and Sugisaki Y (2003) Pathogenesis and Protection of Ischemia and Reperfusion Injury in Myocardium, Journal of Nippon Medical School, 10.1272/jnms.70.384, 70:5, (384-392), . Jung Y, Jung Y, Kim M, Kim M, Lee S, Yi K, Yoo S, Lee S, Baik E, Moon C and Cho J (2003) KR-31466, a Benzopyranylindol Analog, Attenuates Hypoxic Injury Through Mitochondrial KATP Channel and Protein Kinase C Activation in Heart-Derived H9c2 Cells, Journal of Pharmacological Sciences, 10.1254/jphs.92.13, 92:1, (13-18), . HIZOH I and HALLER C (2002) Radiocontrast-Induced Renal Tubular Cell Apoptosis, Investigative Radiology, 10.1097/00004424-200208000-00003, 37:8, (428-434), Online publication date: 1-Aug-2002. October 16, 2001Vol 104, Issue 16 Advertisement Article InformationMetrics https://doi.org/10.1161/hc4101.096829 Originally publishedOctober 16, 2001 PDF download Advertisement
Referência(s)