Mitral valve replacement complicated by iatrogenic left ventricular outflow obstruction and paravalvular leak: case report and review of literature

• Published in: BMC cardiovascular disorders Vol. 15; no. 1; p. 119
• Main Authors: Lee, Justin Z, Tey, Kai R, Mizyed, Ahmad, Hennemeyer, Charles T, Janardhanan, Rajesh, Lotun, Kapildeo
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09.10.2015; BioMed Central
• Subjects: Ablation Techniques; Aged; Albumin; Aortic Valve - surgery; Aortic Valve Insufficiency - surgery; Case Report; Female; Health aspects; Heart Valve Prosthesis Implantation - adverse effects; Humans; Iatrogenic Disease; Medical errors; Mitral Valve - surgery; Mitral Valve Insufficiency - surgery; Prosthesis Failure - etiology; Proteins - therapeutic use; Septal Occluder Device; Ventricular Outflow Obstruction - etiology; Ventricular Outflow Obstruction - surgery
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-015-0108-z

Left ventricular outflow tract (LVOT) obstruction and paravalvular leak (PVL) are relatively uncommon, but are serious complications of prosthetic valve replacement. We present a case that displays the unique therapeutic challenges of treating a patient who developed both LVOT obstruction and mitral PVL after undergoing surgical aortic and mitral valve replacement (MVR). We also describe the use of alcohol septal ablation and albumin-glutaraldehyde (BioGlue) for septal ablation to percutaneously treat the patient's LVOT obstruction, followed by use of an Amplatzer vascular plug for percutaneous closure of an antero-medial mitral PVL associated with severe regurgitation. Percutaneous interventional management of these entities may be considered as an initial therapeutic option, especially in high-risk patients with significant morbidity and mortality of repeat surgical operations.