Percutaneous transcatheter closure of a mitral paravalvular leak via anterograde approach without arteriovenous loop in a patient with double valve replacement

Paravalvular leak (PVL) is a rare but potentially serious complication of surgically implanted prosthetic heart valves. Patients who have PVL can be asymptomatic or present with haemolysis, heart failure, or endocarditis. The goldstandard treatment for prosthetic-valve PVL is surgery to repair or replace the valve but carries higher operative risk compared to the initial procedure. In view of this, percutaneous transcatheter closure of PVL is becoming an increasingly attractive alternative strategy. In this report, we describe a case of mitral PVL in a patient with double-valve replacement, which was successfully closed using Cocoon duct occluder device (Vascular Innovations Co., Ltd, Thailand) via ante-grade approach, guided by transesophageal echocardiography (TEE) and fluoroscopy and without complete arterio-venous loop.