Paravalvular leak closure and ventricular septal defect closure

This chapter discusses the fundamental principles of paravalvular regurgitation evaluation and percutaneous closure. Transthoracic echocardiography (TTE) is usually the first line imaging modality to detect paravalvular regurgitation. Real-time three-dimensional transesophageal echocardiography (TEE) overcomes some of these challenges and allows accurate detection of the location and severity of paravalvular regurgitation. Aortic paravalvular regurgitation is typically localized using the transthoracic aortic short axis view and identifying the regurgitation in relation to one of six sectors each equaling 60°, based on position on the valve leaflets. Ventricular septal defects (VSD) can be divided into congenital and acquired etiologies resulting from either myocardial infarct or post-surgical changes. Catheter VSD closure in indicated for heart failure symptoms, left heart chamber enlargement/volume overload, and previous endocarditis. Transcatheter VSD closure has emerged as an effective and safe treatment in selected patients with appropriate indications.