CASE REPORT article
Front. Cardiovasc. Med.
Sec. Structural Interventional Cardiology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1558686
Moderate to Severe Paravalvular Leak Regurgitation after Recurrent Prosthetic Valve Endocarditis in a patient with Double-Chambered Right Ventricle associated with restricted Membranous Ventricular Septal Defect
Provisionally accepted
Cosimo Sacra1Antonio Totaro2Giuseppe Triggiani1Andrea Romano1Pasquale Pastore1Chiara Galluccio1
Eustaquio Maria Onorato3*- 1Interventional Cardiology Unit, Responsible Hospital, Campobasso, Italy
- 2Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy, Interventional Cardiology Unit, Responsible Hospital, Campobasso, Italy
- 3University Cardiology Department, IRCCS Galeazzi-Sant’Ambrogio Hospital, Milan, Italy
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Background: Managing aortic paravalvular leak (PVL) regurgitation following multiple surgical aortic valve replacements (SAVRs) due to recurrent infective endocarditis (IE) presents significant clinical challenges.Case Summary: A 46-year-old woman with a history of severe aortic regurgitation and an asymptomatic membranous ventricular septal defect (pmVSD) underwent SAVR with a bioprosthetic aortic valve (Perimount 23 mm) in 2005. Concomitantly, a double-chambered right ventricle (DCRV) was diagnosed. Ten years later, due to recurrent IE, another bioprosthetic valve replaced the valve (Magna Ease #25). In 2018, she developed sepsis from Bordetella hinzii endocarditis, leading to a third SAVR in 2019, this time with a mechanical aortic valve (On-X® #23). In 2024, two-dimensional transesophageal echocardiography (2D TEE) revealed moderate-to-severe PVL regurgitation near the right coronary cusp. After a multidisciplinary evaluation, transcatheter PVL closure was planned. Under general anesthesia and TEE/angio-fluoroscopic guidance, the PVL was successfully crossed via the right femoral artery, and a 10×4 mm Occlutech Paravalvular Leak Device (PLD) was deployed. Post-procedural imaging confirmed effective PVL closure with a trace-mild residual leak.Discussion: This case highlights the feasibility of transcatheter PVL closure as a less invasive alternative for patients with multiple prior SAVRs and high surgical risk. Advanced imaging techniques were crucial in procedural success, ensuring precise device placement. A multidisciplinary heart team approach is essential for optimizing outcomes in complex valve pathology. Long-term follow-up is necessary to monitor the durability of closure and potential complications
Keywords: Infective endocarditis, surgical aortic valve replacement, paravalvular leak regurgitation, paravalvular leak closure, double-chambered right ventricle, membranous ventricular septal defect.
Received: 10 Jan 2025; Accepted: 22 Apr 2025.
Copyright: © 2025 Sacra, Totaro, Triggiani, Romano, Pastore, Galluccio and Onorato. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Eustaquio Maria Onorato, University Cardiology Department, IRCCS Galeazzi-Sant’Ambrogio Hospital, Milan, Italy
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