Have you or someone you know had heart valve replacement surgery? After a while, the tissue around the new valve can sometimes start to leak a little. This is what we call a 'Paravalvular Leak' or PVL in medical terms. This type of leak can cause symptoms like shortness of breath and fatigue. So today we're going to talk about a simple treatment that can seal off a leak like this without having to go through major surgery again.
What is Paravalvular Leak Closure?
Simply put, this is a non-surgical treatment. Imagine that you have a prosthetic valve implanted in your heart, but now the valve is leaking a little bit. In the past, to fix something like this, you would have to open your chest again and have open-heart surgery. But not everyone can afford to have surgery again, it's risky.
Here is a solution to this, a treatment called Paravalvular Leak (PVL) Closure has come up. In this, an interventional cardiologist uses a very thin tube called a catheter to go to the leak in the heart and closes the hole with a small device (closure device). It's like putting a 'seal' on a small hole in a water pipe.
Since this is not a surgery, the recovery time is short, the risks are low, and the hospital stay is very short.
Who needs this treatment?
Not everyone with a prosthetic valve will develop this condition, and not everyone with a leak will need this treatment. It is usually recommended for people with a severe leak that cannot be controlled with medication. Your doctor will decide if this treatment is right for you.
This treatment may be suitable for someone with the following conditions:
| Condition | Simple explanation |
|---|---|
| Severe bleeding | If the leak causes a lot of blood to flow in the wrong direction. |
| Difficulty breathing (Dyspnea) | If you have difficulty breathing even during normal activities. |
| Hemolytic Anemia | Anemia occurs due to the breakdown of red blood cells as blood passes through the leak. |
| People undergoing treatment for endocarditis | If you are being treated for an infection of the inner lining of the heart. |
| Those at high risk of re-surgery | For those who have already had several surgeries and cannot afford another surgery. |
What do you do before treatment?
Before performing this treatment, your doctor will carefully examine your health. He will perform various tests to check your heart function.
- ECG (Electrocardiogram): View the electrical activity of the heart.
- Echocardiogram: A scan of the heart.
- Transesophageal Echocardiogram (TEE): This is a special scan. A small camera is passed through the esophagus to see the heart valves very clearly. This is very important for finding the exact location of the leak.
- Cardiac CT scan or MRI: Obtain detailed three-dimensional (3D) images of the heart.
- Blood tests: Check for infections.
It is very important to tell your doctor about any allergies you have and all medications you are taking (especially blood thinners).
What happens during treatment?
This treatment is usually done in a hospital's cardiac catheterization lab. You will be given medication and anesthesia to prevent pain.
After that, the specialist follows these steps:
1. Insertion of the catheter: A very thin, flexible tube (catheter) is inserted into a large blood vessel (femoral artery) in your groin.
2. Going to the leak site: Using scanning technology (such as TEE), a wire is passed through the tube and guided to the exact location of the leak in the heart.
3. Device placement: Once the exact location of the leak is identified, a special small device (closure device) that can close the hole is passed through the catheter, set in the hole, and closed.
4. Removing the catheter: Once the work is done, the catheter and wires are carefully removed.
The entire process usually takes about two to three hours. Over time, your heart tissue grows around the newly inserted device, making it a part of your heart.
After the treatment and its benefits
Usually, you only have to stay in the hospital for one night after this treatment. You can go home the next day. The doctor will advise you on how to stay after you go home, what to do and what not to do. Usually, you will be re-examined in about three months to see if the leak is properly closed and if the valve is working properly.
Some of the advantages of this method compared to open surgery are:
- Fast recovery: Since there is no major incision, you can resume your normal activities quickly.
- Low risk of infection: Since there is no major wound, the risk of infection is very low.
- Shorter hospital stay: You can go home overnight.
- Small scars: Just a small hole in the groin, no big scar on the chest.
When do you want to see the doctor again?
After treatment, it is essential to follow your doctor's instructions exactly and attend clinics on scheduled dates.
If you develop an unexplained fever, pain or swelling in the groin area, or any other unusual symptoms, notify your doctor immediately .
If you have had a heart valve replacement, it is very important to have regular medical checkups. Because sometimes this type of leak can occur. But the best thing is that this can now be treated without surgery. Talk to your doctor to decide what treatment is best for you.
Take-Home Message
- Paravalvular Leak (PVL) is the leakage of blood around an artificial heart valve after it is implanted.
- PVL Closure is a non-surgical treatment method that closes this leak without opening the chest, using a small device inserted through a catheter.
- This method is very useful for those at high risk of re-surgery and those with severe symptoms.
- This treatment has a shorter recovery time, lower risks, and a shorter hospital stay.
- Be sure to talk to your cardiologist to determine if this treatment is right for you.
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