Transcatheter Paravalvular Leak Closure Using Valve Frame Access

Chloe Kharsa; Mangesh Kritya; Karl Abou Zeid; Charishma Nallapati; Selin Haci; Ponraj Chinnadurai; Nadeen N. Faza; Stephen H. Little; Neal Kleiman; Sachin S. Goel; Joe Aoun

doi:10.1016/j.jaccas.2026.107545

Transcatheter Paravalvular Leak Closure Using Valve Frame Access

Chloe Kharsa, Mangesh Kritya, Karl Abou Zeid, Charishma Nallapati, Selin Haci, Ponraj Chinnadurai, Nadeen N. Faza, Stephen H. Little, Neal Kleiman, Sachin S. Goel, Joe Aoun

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: To describe a step-by-step approach to transcatheter paravalvular leak (PVL) closure after transcatheter aortic valve replacement (TAVR) using frame-based access through a self-expanding valve. Key Steps: An 85-year-old man with a 34-mm Evolut FX+ TAVR valve developed worsening heart failure. Multimodality imaging showed moderate to severe PVL with adverse left ventricular remodeling. Preprocedural computed tomography localized a dominant jet aligned with a misaligned diamond-shaped cell of the Evolut valve. A closure device was delivered through this cell, markedly reducing PVL. Potential Pitfalls: Inadequate multimodality imaging may cause incorrect leak localization, device malposition, or longer procedures. Challenges include crossing the PVL tract within the valve frame and avoiding leaflet interference. Balloon postdilation may fail in heavily calcified annuli and adds risk. Take-Home Messages: Severe calcification and commissural misalignment can limit balloon postdilation. Careful computed tomography planning can identify favorable frame-based access (eg, Evolut FX+ diamond cell) and enable effective PVL closure in selected anatomies.

Original language	English (US)
Article number	107545
Pages (from-to)	107545
Journal	JACC: Case Reports
Volume	31
Issue number	17
Early online date	Mar 24 2026
DOIs	https://doi.org/10.1016/j.jaccas.2026.107545
State	Published - Apr 29 2026

Keywords

Evolut FX+
multimodality imaging
paravalvular leak
percutaneous closure
transcatheter aortic valve replacement

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jaccas.2026.107545

Cite this

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title = "Transcatheter Paravalvular Leak Closure Using Valve Frame Access",

abstract = "Objective: To describe a step-by-step approach to transcatheter paravalvular leak (PVL) closure after transcatheter aortic valve replacement (TAVR) using frame-based access through a self-expanding valve. Key Steps: An 85-year-old man with a 34-mm Evolut FX+ TAVR valve developed worsening heart failure. Multimodality imaging showed moderate to severe PVL with adverse left ventricular remodeling. Preprocedural computed tomography localized a dominant jet aligned with a misaligned diamond-shaped cell of the Evolut valve. A closure device was delivered through this cell, markedly reducing PVL. Potential Pitfalls: Inadequate multimodality imaging may cause incorrect leak localization, device malposition, or longer procedures. Challenges include crossing the PVL tract within the valve frame and avoiding leaflet interference. Balloon postdilation may fail in heavily calcified annuli and adds risk. Take-Home Messages: Severe calcification and commissural misalignment can limit balloon postdilation. Careful computed tomography planning can identify favorable frame-based access (eg, Evolut FX+ diamond cell) and enable effective PVL closure in selected anatomies.",

keywords = "Evolut FX+, multimodality imaging, paravalvular leak, percutaneous closure, transcatheter aortic valve replacement",

author = "Chloe Kharsa and Mangesh Kritya and Zeid, \{Karl Abou\} and Charishma Nallapati and Selin Haci and Ponraj Chinnadurai and Faza, \{Nadeen N.\} and Little, \{Stephen H.\} and Neal Kleiman and Goel, \{Sachin S.\} and Joe Aoun",

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doi = "10.1016/j.jaccas.2026.107545",

language = "English (US)",

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T1 - Transcatheter Paravalvular Leak Closure Using Valve Frame Access

AU - Kharsa, Chloe

AU - Kritya, Mangesh

AU - Zeid, Karl Abou

AU - Nallapati, Charishma

AU - Haci, Selin

AU - Chinnadurai, Ponraj

AU - Faza, Nadeen N.

AU - Little, Stephen H.

AU - Kleiman, Neal

AU - Goel, Sachin S.

AU - Aoun, Joe

PY - 2026/4/29

Y1 - 2026/4/29

N2 - Objective: To describe a step-by-step approach to transcatheter paravalvular leak (PVL) closure after transcatheter aortic valve replacement (TAVR) using frame-based access through a self-expanding valve. Key Steps: An 85-year-old man with a 34-mm Evolut FX+ TAVR valve developed worsening heart failure. Multimodality imaging showed moderate to severe PVL with adverse left ventricular remodeling. Preprocedural computed tomography localized a dominant jet aligned with a misaligned diamond-shaped cell of the Evolut valve. A closure device was delivered through this cell, markedly reducing PVL. Potential Pitfalls: Inadequate multimodality imaging may cause incorrect leak localization, device malposition, or longer procedures. Challenges include crossing the PVL tract within the valve frame and avoiding leaflet interference. Balloon postdilation may fail in heavily calcified annuli and adds risk. Take-Home Messages: Severe calcification and commissural misalignment can limit balloon postdilation. Careful computed tomography planning can identify favorable frame-based access (eg, Evolut FX+ diamond cell) and enable effective PVL closure in selected anatomies.

AB - Objective: To describe a step-by-step approach to transcatheter paravalvular leak (PVL) closure after transcatheter aortic valve replacement (TAVR) using frame-based access through a self-expanding valve. Key Steps: An 85-year-old man with a 34-mm Evolut FX+ TAVR valve developed worsening heart failure. Multimodality imaging showed moderate to severe PVL with adverse left ventricular remodeling. Preprocedural computed tomography localized a dominant jet aligned with a misaligned diamond-shaped cell of the Evolut valve. A closure device was delivered through this cell, markedly reducing PVL. Potential Pitfalls: Inadequate multimodality imaging may cause incorrect leak localization, device malposition, or longer procedures. Challenges include crossing the PVL tract within the valve frame and avoiding leaflet interference. Balloon postdilation may fail in heavily calcified annuli and adds risk. Take-Home Messages: Severe calcification and commissural misalignment can limit balloon postdilation. Careful computed tomography planning can identify favorable frame-based access (eg, Evolut FX+ diamond cell) and enable effective PVL closure in selected anatomies.

KW - Evolut FX+

KW - multimodality imaging

KW - paravalvular leak

KW - percutaneous closure

KW - transcatheter aortic valve replacement

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Transcatheter Paravalvular Leak Closure Using Valve Frame Access

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