Transapical access closure of a mechanical mitral prosthesis leak.


A 62-year-old woman with a history of rheumatic mitral valve disease and commissurotomy closed in 1969, implantation of a Shiley biological mitral prosthesis in 1978, and its replacement in 1998 by a No. 25 Bjork mechanical prosthesis, showed symptoms consistent with congestive heart disease and analytical findings indicating hemolytic anemia. Transesophageal echocardiography detected 2 mitral periprosthetic leaks, a severe one at P2 and a mild one at P3 (Fig. 1). A decision was made to close the P2 leak, but because the patient had undergone 3 previous heart surgeries, a minimally invasive approach by transapical route was chosen, this being the simplest technique. The procedure was carried out in the operating room with the patient under general anesthesia. A left minithoracotomy was performed (Fig. 2) with apical access, and an Amplatzer device was implanted over the P2 defect under radioscopic and transesophageal echocardiographic guidance (Fig. 3); the outcome was satisfactory. At hospital discharge 5 days later, the patient was asymptomatic and laboratory analyses showed no hemolysis. At 10 days, a transesophageal echocardiographic follow-up study showed that the procedure had been effective, with only a minimal residual leak. Periprosthetic leaks are a relatively common finding (2% to 3% of mitral prosthesis implantations). When they are severe, they tend to produce symptoms of congestive heart failure or hemolytic anemia. Percutaneous closure is usually contemplated in patients with a history of several previous heart surgeries or multiple comorbid conditions. An anterograde (transapical) or retrograde (trans-septal) approach can be performed, with success rates of 60% to 90%. Figure 1.

DOI: 10.1016/j.recesp.2010.11.026

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@article{Fernndez2012TransapicalAC, title={Transapical access closure of a mechanical mitral prosthesis leak.}, author={L. Fern{\'a}ndez and David Rodrigo and Pedro P{\'e}rez}, journal={Revista espanola de cardiologia}, year={2012}, volume={65 10}, pages={956} }