Mitral valve paravalvular leaks: Comprehensive review of literature

J Card Surg. 2022 Feb;37(2):418-430. doi: 10.1111/jocs.16145. Epub 2021 Nov 25.

Abstract

Background: Mitral paravalvular leaks (mPVL) are a recognized complication for patients with mitral valve prostheses. Although clinically insignificant for many patients, it may pose life-threatening haemolysis and regurgitation-induced heart failure, and so clinicians should have a high index of suspicion in the presence of new symptoms.

Aims: This review discusses the pathogenesis, clinical features, diagnosis, imaging and treatment of mPVLs.

Methods: A comprehensive literature search was performed using PubMed, EMBASE, Cochrane database, Google Scholar and Ovid. Search terms used included "mitral valve paravalvular leak," "transthoracic echocardiography," "2D transoesophageal echocardiography," "3D transoesophageal echocardiography," "cardiac computed tomography," (CT) "cardiac magnetic resonance imaging," "intracardiac echocardiography," "cinefluoroscopy," "fluoroscopy," and "percutaneous closure."

Results: All patients with mPVLs should undergo regular full evaluation, including patient history, physical examination, laboratory work-up, imaging, and referral, if necessary. Echocardiography is fundamental to the diagnosis, and is augmented with cardiac magnetic resonance imaging, cardiac computerized tomography and fluoroscopy for further characterization and procedural planning amongst the structural heart team.

Conclusion: The prevalence of mPVL is expected to increase proportionally to the growing number of surgical and transcatheter valve replacements conducted in the ageing population. Multimodal imaging is instrumental in guiding diagnostic and therapeutic strategies when managing mPVLs. Advances in imaging and capabilities of transcather devices will prompt growing uptake of percutaneous treatment over conventional, higher-risk surgery for mPVL management.

Keywords: echocardiography; mitral valve; paravalvular leak; transcatheter closure.

Publication types

  • Review

MeSH terms

  • Cardiac Catheterization
  • Echocardiography, Transesophageal
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis* / adverse effects
  • Humans
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / surgery
  • Mitral Valve Insufficiency* / diagnostic imaging
  • Mitral Valve Insufficiency* / etiology
  • Prosthesis Failure