PMC8086695_01
A. Two-dimensional transesophageal echocardiography (2D TEE) view of paravalvular regurgitation; B. Fluoro image: the leak was crossed with a straight wire; C. Fluoro image: after venoarterial loop was created, an Amplatzer Vascular Plug III device (AVPIII) 12 x 5-mm device (yellow arrow) was deployed; D. 2D TEE image showing no paravalvular regurgitation; E. 3D TEE image showing AVPIII device; F. Computed tomography image showing incomplete left atrial appendage (LAA) ligation (blue arrow); G. Fluoro image: baseline left atrial appendage angiogram; H. Fluoro image: after deployment of an AVPII 16 mm device (white arrow); I. 3D TEE image showing the position of both devices.
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A transesophageal echocardiography showed a lateral paravalvular leak (12 x 6 mm) in the prosthetic mitral valve (Fig. 1A). Percutaneous closure of the paravalvular leak was performed (Fig. 1B, C) with an Amplatzer Vascular Plug III device (12 x 5 mm) (St. Jude Medical) with no residual regurgitation detected (Fig. 1D, E). After a LAA angiogram identified incomplete ligation (Fig. 1G), a 16 mm Amplatzer Vascular Plug II device (St. Jude Medical) was placed via 8 Fr Mullins sheath which sealed the orifice with no residual flow (Fig. 1H, I).