Closure of aortic paravalvular leak under intravascular ultrasound and intracardiac echocardiography guidance.

Aortic paravalvular leaks after aortic valve replacement surgery - though not uncommon as an incidental finding - may become clinically significant in up to 5% of patients. Open surgical correction by either direct suturing or patching of the defect or reoperative valve replacement is associated with significant morbidity and mortality. Relatively few case reports are available in the literature addressing percutaneous closure of aortic paravalvular leaks. We describe the novel use of intracardiac echocardiography and intravascular ultrasound to guide closure strategy selection and subsequent deployment of an Amplatzer duct occluder device. The patient experienced immediate subjective and hemodynamic improvement accompanied by rapid resolution of heart failure symptoms from New York Heart Association (NYHA) class IV to NYHA class II. This marked clinical improvement has been sustained at 9 months to date and 4-month follow-up echocardiography confirmed complete resolution of aortic regurgitation as the mechanism behind this improvement.