Device entrapped in subvalvular apparatus: A surprising result

( u ( S E t l m S d p 58 days after admission (one month after the procedure). This case illustrates a rare and dramatic complication of percutaneous leak closure, but without significant hemodynamic impact on mitral valve and LV function. A 72-year old woman with a history of mechanical aortic prosthesis since 2010 and early infective prosthetic endocarditis (medical treatment) was hospitalized for acute heart failure in February 2015. Transesophageal echocardiography showed a severe paravalvular leak in the posterior portion of the aortic prosthesis (Figure 1A, arrow) and a pseudoaneurysm with fistulization to the left ventricle (LV) and aorta (Figure 1B, arrow), moderate mitral regurgitation and mild LV systolic dysfunction. Surgery was considered high risk and percutaneous closure of the paravalvular leak was attempted. The procedure was guided by fluoroscopy and transesophageal echocardiography. After confirming the stability of the device (Amplatzer ® Vascular Plug II 12 mm/9 mm) and reduction of the paravalvular leak without functional compromise of the mechanical prosthesis