Tricuspid paravalvular leak closure with a paravalvular leak device

A 69-year-old man, with a permanent pacemaker (PM) and a tricuspid bioprosthesis implanted 6 years ago, was admitted due to gradual exacerbation of heart failure symptoms to NYHA class III. Transthoracic (TTE) and transesophageal (TEE) echocardiography revealed proper function of bioprosthesis leaflets accompanied by the presence of severe paravalvular leak (PVL) with the PM lead crossing its channel. The paravalvular backflow velocity was 3.3 m/s with a calculated right ventricle (RV) to right atrium (RA) gradient of 43 mm Hg and regurgitant volume of 45 ml on TTE. On three-dimensional (3D) TEE the PVL was oval-shaped with dimensions of 7 × 10 mm (Figure 1 A). The interatrial septum (IAS) appeared to be shoved towards the left atrium (LA) with reversed, rightto-left shunt across the patent foramen ovale (PFO). No significant pathology was visualized within the left heart chambers. The Heart Team consulted the patient and a transcatheter closure was scheduled. The procedure was performed in general anesthesia under real time (RT) 3D TEE and fluoroscopy guidance. A rectangular waist-type 8 × 4 mm Paravalvular Leak Device [1] (PLD, Occlutech GmbH) was implanted with a standard vendor