Paravalvular Leak Closure

Paravalvular Leak Closure

What is a paravalvular leak?

A paravalvular leak is a problem that can occasionally be seen in patients who have had a valve replacement where there is a leak around the replaced valve. This could be a surgical valve replacement (a tissue or mechanical valve) or a percutaneous valve replacement (such as a TAVI). In some patients it is seen soon after the valve procedure, in some it presents later sometimes spontaneously, sometimes after a valve infection (known as infective endocarditis).

How is paravalvular leak closure diagnosed?

Any patient who has had previously had valve surgery or intervention will generally be under regular cardiology follow-up. A paravalvular leak may be identified because you have a new heart murmur, or it may be identified on an echocardiogram (ultrasound scan of the heart).

What are the symptoms?

There may be no symptoms. The most common symptom is breathlessness, which may be quite subtle. In some patients it may just be that they never quite got back to normal after heart surgery. Rarely, the leak may damage blood cells (known as haemolysis) causing a low blood count (anaemia).

How is it treated?

In patients with a very mild leak, it may not need any treatment at all, except for monitoring. In patients with a more severe leak, one option to consider is paravalvular leak closure. This is a specialised procedure where a soft metal mesh plug is put inside the leak, either reducing it or stopping it entirely. This procedure takes an hour or two and is done through one of the arteries or veins in the groin, without open heart surgery. Most patients are in hospital for one night after the procedure. In most patients, paravalvular leak closure is a low risk procedure, and your specific risks will be discussed before the procedure. The procedures are carried out with a team, including an interventional imaging expert and a cardiac anaesthetist. The other option for treating a paravalvular leak is redo open heart surgery.

What experience does Dr Dawkins have in treating paravalvular leaks?

Dr Dawkins is the Clinical Lead for Structural Intervention in Oxford and runs the paravalvular leak programme. He is the the only interventional cardiologist in the region who does the paravalvular leak closure procedure. He treats patients from across the South of England, from the local area and as far afield as Devon and Cornwall.

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    Dr Dawkins has private clinics in Oxford at the Nuffield Manor Hospital and in London at Cleveland Clinic London. Please get in touch if you would like to make an appointment. We can usually arrange to see you within a few days. For urgent appointments, a same-day visit or telephone consultation can often be arranged. To arrange an appointment, please complete this form or call us on 020 7205 2024 (London) or 01865 598040 (Oxford).