Paravalvular leak (PVL) is a rare condition that happens after valve replacement surgery. This occurs due to a gap between the tissue of the patient’s heart and the replaced valve.
Paravalvular leak (PVL) occurs in patients who have once had a heart valve replacement. This is usually a mitral valve replacement, but can also occur in aortic and tricuspid valve problems. It occurs when gaps occur between the tissue around the valve and the valve itself which allows blood to leak back through to the wrong chamber.
There may be no symptoms associated with small leaks. However, with larger leaks, symptoms of heart failure can develop such as breathlessness, problems lying flat, swollen ankles and tiredness. It can also cause anaemia because the blood cells are broken down in the turbulent jets arising from the leak. .
A paravalvular leak will be suspected if you present with symptoms of heart failure having had a valve replacement previously. The key test is an echocardiogram (ultrasound ) which can identify the leak and the effects on the rest of the heart. If the problem is with the mitral valve it can be difficult to see a paravalvular leak and a transoesophageal echocardiogram (TOE) may be required which is very good finding the exact location of the leak. For a more precise diagnosis, the cardiologist may recommend an MRI or a CT scan since they can also help in locating the location of the leak and the relationship to other structures. You will also need blood tests to see if the paravalvular leak has caused anaemia.
The options depend on your symptoms and the serverity of leak. If you are have no symptoms or the leak is only mild, it is likely that monitoring is all that will be required. If you have symptoms of heart failure or anaemia and the leak is severe, then treatment may be considered.
In some cases, repeat cardiac surgery may be considered but the risks of this are considerable and in most cases a keyhole procedure is offered from the top of the leg to insert a device to plug off the leak.
This is a complicated procedure with some risks and your doctor will explain clearly the issues. It is possible to reduce the leak significantly in 8 to 9 out of 10 cases. There is a risk of the closure device interfering with the valve function, or of the closure device falling out and travelling elsewhere which may require urgent surgery. There is also a risk of bleeding.
A paravalvular leak is a complex problem requiring expert assessment and decision-making. Our expert Consultant Cardiologists are specialists in assessing structural problems with the heart and are available for consultation on any day of the week and weekends as well.
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