Valve in valve procedure and paravalvular leaks

Bioprosthetic heart valves, despite best attempts at tissue treatment will suffer from degeneration. This can occur due to structural deterioration of the valve leaflets (e.g. calcium accumulation and scar formation leading to immobile and obstructive to the blood flow or perforation and tears leading to severe leakage). Occasionally, deterioration can occur when holes, gaps or slits occur outside the surgical valve due to disruption of previously placed sutures

heart valvesValve in Valve Procedure

The traditional option was to consider a redo open-heart surgery to remove the deteriorated heart valve and sew in a new heart valve. There is now another option of treatment. This involves inserting a transcatheter heart valve within the old heart valve. This is called a valve in valve procedure. This restores a new set of valve leaflets to the previously damaged valve. The benefit is that the procedure can be done without the need to open the chest again. This is especially suited for high-risk patients.

If the deterioration is due to leaks outside the valve, we call this paravalvular leaks, we can also place a transcatheter vascular plus to seal these defects. This requires a specialized 3-dimensional echocardiogram which can demonstrate the gap clearly (figure B with arrows). A catheter is inserted and a plug is delivered to the gap and deployed (Figure F)