Percutaneous closure of paravalvular prosthetic mitral leak requiring acute hemodialysis

A case of a severe paravalvular mechanical mitral prosthesis leak in a high-risk patient that underwent previously 4 mitral valve surgeries is described. An Amulet-Amplatzer device was correctly implanted on the left atrial appendage, with the temptative to close also the contiguous severe leak. A residual moderate paravalvular leak caused acute hemolysis with severe renal failure requiring hemodialysis. The transesophageal echocardiogram is crucial in localizing and defining the extent of the paravalvular leak. It is not clear if the hemolysis was precipitated by the evolution of the disease or by the residual regurgitation after Amulet device deployment. Certainly, given the intricacy of the procedure the results might be limited also for highly expert operators. To our knowledge, this is the first case reporting the use of the Amulet-Amplatzer device for paravalvular leak closure.