Perpendicular and turbulent flow in acute aortic paravalvular leak: case report

Paravalvular leaks (PVL) are well-recognized complications after artificial valve replacement and symptomatic periprosthetic leaks are closely associated with increased mobility and mortality. Owing to the difference in types of prosthetic valve and options of suture technique, echocardiography of PVL can be diverse and challenge to diagnose. Herein, we report a patient with continuous low cardiac output syndrome on the second day after surgery after aortic replacement, which was misdiagnosed as coronary-left ventricular fistula by transthoracic echocardiogram (TTE). However, transesophageal echocardiogram (TEE) detected a perpendicular and turbulent jet flow from the outer side of the sewing ring, which was eventually diagnosed as an acute aortic PVL combined with cardiac angiography. The significant PVLs were treated by reoperation previously, while they are recommended for transcatheter closure recently. This patient was received successful percutaneous closure by the Cardi-O-Fix Plug. The cardiac symptom was relieved without additional complications. This report highlights the important role of multi-modality imaging, including the combination of TTE, TEE and cardiac angiography, in the diagnosis and treatment of PVL. Percutaneous closure is an appropriate option for the repair of PVL with long-term symptom relief and reduced mortality compared to reoperation. Therefore, this article describes the diagnosis and treatment of this patient with acute aortic PVL.