By Dr Paul Chiam
Published on Mosaic Quarter 4 2014

Patients with paravalvular leakages can now benefit from a speedier recovery with more advanced minimally invasive surgery.

Paravalvular leak is a post-surgery complication that occurs in up to 10 per cent of patients who have had heart valve replacement surgery. During a heart valve replacement, the damaged heart valve is replaced with a man-made valve.

Leakage occurs when the surgical stitches that secure the implanted valve to the patient’s heart tissue deteriorate and break down, causing gaps to appear. If left untreated, the leakage of blood may lead to more severe conditions such as hemolysis, which is the breakdown of red blood cells, or heart failure.

Conventional treatment requires a repeat invasive open heart procedure to repair the leak or replace the entire valve implant. However, patients now have the option of a more advanced procedure known as percutaneous paravalvular leak repair at Mount Elizabeth Hospital.

In contrast to conventional repair methods, percutaneous paravalvular leak repair does not require re-opening the chest cavity. This minimally invasive procedure lowers the risk of complications. It is performed by creating a small puncture in the groin to allow a tube to be inserted through a large artery or vein in the thigh. With the use of guidewire and advanced imaging, small ‘plug-like devices’ are implemented into the leakage site to seal the gap.

Due to its technical complexity, the surgery calls for the skill of a trained interventional cardiologist. However, the down time is significantly shorter than that of previous treatment options. The surgery can be completed in just a few hours, and most patients can be discharged the following day.

Recently, I treated a 66-year-old Indonesian male who suffered from paravalvular leakage. The patient’s condition affected his breathing and mobility badly and open heart surgery would have placed him at a higher risk of complications. After undergoing a successful percutaneous paravalvular leak repair procedure that was performed in Mount Elizabeth Novena Hospital, the leakage was significantly reduced and the patient was discharged overnight. He can now walk unaided for much longer distances.

With the increasing number of patients with heart valve replacements in Asia and expected rise in the cases of valve leakage, particularly in Southeast Asia, this minimally invasive approach is already gaining momentum.