Device's dehiscence 3 months after implant for mitral perivalvular leak

Our case is about a complication in a case of percutaneous closure of a perimitral leak in a patient with beleaflet mechanical mitral prosthesis. An Amplatzer vascular plug III was implanted. At the time of procedure the leak was successfully closed, however after three months a device's dehiscence developed. Percutaneous closure of mitral perivalvular leak is currently a feasible alternative in highly selected individuals, whose symptoms are not adequately palliated by medical therapy and who are at high surgical risk. Our case demonstrates that the presence of a wide calcification of the native annulus may represent a contraindication to this kind of treatment. Further studies on percutaneous approaches to perivalvular prosthetic regurgitation in presence of heavy calcification are needed, in order to define optimal patient selection and the late complications of this procedure. Moreover it will also be useful to design a device adapted for the anatomy of such defects in various sizes.