Utility of guide catheter extension and intravascular ultrasound to facilitate transcatheter device closure of aortic paravalvular leak

Paravalvular leak (PVL) refers to the retrograde flow of blood through a channel between an implanted valve prosthesis and native cardiac tissue, due to the absence of an appropriate seal. Most PVLs are haemodynamically non-significant; however, large leaks can present with symptoms of heart failure and/or haemolysis, with impact on quality of life. In many patients, re-operation is associated with high risk and alternative treatments using transcatheter closure techniques have been applied. We present the case of a septuagenarian male who underwent aortic PVL closure facilitated by use of a guide catheter extension and intravascular ultrasound. This report illustrates that these adjunctive techniques, more commonly used in coronary angioplasty procedures, can be used to enable complex PVL closure.