Transcatheter closure through transapical access for mitral paravalvular leak after previous trans-septal mitral operation

Because paravalvular leak after mitral valve replacement in highly morbid patients is a troublesome issue, there has been a growing interest in less invasive procedures. We conducted transcatheter paravalvular leak closure of a mitral valve prosthesis through left ventricular apical access. The patient had undergone redo mitral valve replacement through a transatrial septal approach 2 months prior to the procedure; thus, penetration of the atrial septum was considered to be difficult through the ordinary antegrade trans-septal approach. Transapical access for the mitral paravalvular leak was conducted using two AMPLATZER Vascular Plugs (St. Jude Medical, St. Paul, MN), with a route directed straight to the defect. This approach is an alternative technique for transcatheter paravalvular leak closure. This is the first case report of transapical access for transcatheter paravalvular leak closure in Japan.