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Aortic Valve Peravalvular Leak

This article reviews the risk factors associated with aortic valve perivalvular leaks, highlighting the roles of endocarditis, calcified annulus, and bicuspid aortic valves. It discusses findings from studies involving 84 patients, where 40 developed small leaks, which remained stable over time. Additionally, the text covers surgical outcomes related to paraprosthetic leaks and identifies key intraoperative echocardiography practices that can help assess and manage perivalvular leaks effectively. Considerations for long-term follow-up and monitoring for severe regurgitation complications are outlined.

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Aortic Valve Peravalvular Leak

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  1. Aortic Valve Peravalvular Leak

  2. Risk factors for Aortic Valve Peravalvular Leak • Endocarditis • calcified annulus • bicuspid aortic valve • Note many present with significant annular calcification • Marfan Syndrome

  3. Rallidis et al (1999) • Studied 84 consecutive patients with aortic valve replacements • Patients studied prospectively at early (11days), Mid (27months) and late (63 months) intervals. • 40 patients developed leaks early, 90% of these were small and did not change over time. Patients did well. •  3 patients developed severe paraprosthetic regurgitation late related to endocarditis one patient had degenerative tissue valve failure. •  Concluded: Small leaks usually have a benign course. Development of new severe regurgitation should raise concern of endocarditis or prosthetic valve failure.

  4.  DeCicco et al (2005) • Multi centre study: • 1,696 patients undergoing AVR • 39 (2.3%) with paraprosthetic leak • Symptoms in patients with paraprosthetic leak • 71.4% Heart Failure • 17.8% Hemolysis • 10.8% none • 28 people underwent surgery • 20/28 valve replaced • 8/28 Prosthetic leak closed by sutures • surgical mortality 7%

  5.  Role of Echocardiographer Intraoperatively • Preprocedure: • Assess risk factors for Peravalvular leak • annular calcification • endocarditis/abscess • Post aortic valve replacement • Diligently search for Peravalvular leak • Diligently search for fistula into RA/LA/RVOTEspecially focus in areas of heavy calcium or abscess. •  Define location and severity.

  6. Illustration of Aortic Prosthesis Peravalvular LeakCase #1 • Status post placement of prosthetic peravalvular leak noted immediately post bypass. • Surgeon notified, location defined. • Surgeon able to place annular stitches off bypass. Leak no longer present. (not shown)

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  8. Illustration of Aortic Prosthesis Peravalvular LeakCase #2 • 58 yr old man presenting with bicuspid aortic valve with stenosis. • Prebypass echo notes severe leaflet and annular calcification.

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  11. Post Bypass Case #2 • Note peravalvular leak, adjacent to left main coronary artery. • Peravalvular leak not addressed.

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  14. Case #2 • Patient returns 3 months later with symptoms. • On echo has peravavluar leak and prolapse prosthetic valve leaflet.

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  19. Case #2 • Patient under went successful aortic valve replacement without complications.

  20.  References: •  DeCicco, Beghi et al: Aortic Valve Periprosthetic Leakage: Anatomic Observations and Surgical Results. Ann Thorac Surg 2005;79:1480-5. • Rallidis et al: Natural History of Early Aortic Paraprostheitc Regurgitation: A Five Year Follow-up. Am Heart J 1999 Aug;138(2Pt 1):351-7. • O’Rourke et al: Outcome of Mild Periprosthetic Regurgitation Detected by Intraoperative Transesophageal Echocardiography. J Am Coll Card 2001;38:163-6.

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