CARDIOVASCULAR JOURNAL OF AFRICA • SMC-PAFCIC Abstracts October 2022 55 AFRICA Submission ID: 1678 PERCUTANEOUS TRANSCATHETER CLOSURE OF MITRAL PROSTHETIC PARAVALVULAR LEAKS: A CASE REPORT ABDELJELIL FARHATI, FATHIA MGHAIETH, ZEINEB OUMAYA, ZEYNAB JEBBERI, AYMEN FTINI, WALID SELIMEN, MANEL BEN HALIMA, MOHAMED SAMI MOURALI TUNISIA Background: Paravalvular leak (PVL) is a potentially life-threatening complication after valve replacement, leading to heart failure, hemolysis, and infective endocarditis. While the gold standard in the treatment of prosthetic valve PVL is surgery, it has a higher operative risk than the initial procedure, with an increased incidence of recurrent leakage. Percutaneous PVL closure is an emerging treatment approach, especially for patients at high surgical risk or who refuse surgery. It is a technically complex procedure and is not practiced in many centers. Case report: We report the case of a 71-year-old woman who was referred with refractory congestive heart failure and severe hemolysis caused by two severe PVL of a Starr-Edwards valve implanted in mitral position 33 years before. Owing to the perceived high surgical risk, percutaneous paravalvular leak closure was performed. We opted for a transseptal approach, under general anesthesia and with guidance by trans esophageal 3D echocardiography. The procedural complexity was heightened by the type of prosthesis (Starr-Edwards mitral prosthesis) with a potential risk of ball blockage. We used an “anchor wire” technique. Percutaneous closure with an Amplatzer TM APVL III 6 x 3mm and a VSD occluder 8 x 4mm was successfully performed. Post-procedure echocardiographic control confirmed the effective PVL closure, with a large anterior leak, scheduled for a second time. At the three-month follow-up, she presented a stable dyspnea NYHA II class and moderate hemolytic anemia related to the untreated leak. In the second procedure, we opted for an anterograde transseptal approach. Advancing the delivery sheath was not possible via this approach. We opted for an arteriovenous loop technique by snaring the wire and externalizing it through the femoral artery, allowing the passage of the catheter and then the devices implantation. She showed a relevant clinical improvement with a good quality of life at a one-month follow-up. Loop. Conclusion: Mitral PVL transcatheter closure needs complex techniques of catheterization. It should only be performed by a structural and imaging cardiology team with a special experience in advanced structural procedures, supported by careful preprocedural planning. Submission ID: 1682 EFFECTS OF PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY ON LEFT VENTRICULAR, RIGHT VENTRICULAR AND LEFT ATRIAL DEFORMATION IN PATIENTS WITH ISOLATED AND SEVERE MITRAL STENOSIS: A STRAIN ANALYSIS ZINEB FASSI FEHRI, ZINEB AGOUMY, SAMAH EL-MHADI, SAMAH EL-MHADI, HAMZA CHRAIBI, NADIA FELLAT, NESMA BENDAGHA, ADIL BENSOUDA, AIDA SOUFIANI, ROKYA FELLAT TUNISIA Background: Previous studies have reported abnormal left ventricular (LV) contraction in patients with mitral stenosis (MS), but presently we do not have enough objective informations about right ventricular mechanics. The aim of our prospective single center study was to explore the serial changes in left and right ventricular (RV) mechanics in patients with severe MS undergoing balloon mitral valvuloplasty (BMV) to understand the reversibility of the abnormal contractile function. Patients and methods: The study included 30 patients with severe MS and 15 age-matched healthy individuals. 2D speckle-tracking-based LV and RV global longitudinal strain (GLS) measurements were performed for each participant. In patients with MS, the same measurements were repeated 72h hours after BMV. Results: The mean age of patients with MS was 41±13 years (vs 37±11 in the healthy control group) with a majority of women (92%). 57% were in NYHA class II and 19% in class III. There were no significant differences between heart rate and LV ejection fraction in patients with MS compared to control group (P=0.16) and between LV ejection fraction before and after BMV. The magnitude of LV and RV GLS was significantly reduced in patients with MS (P=0.001 for each parameter) whith a normal LV ejection fraction (61,5 ± 4%). In the control group, the 2D LV and RV GLS were respectively -21±1.14% and -24±4.2%. After BMV, we note a significant improvement in GLS (-13±2% vs -15±3%), and a significant decrease of left atrial volume (143±56ml vs 130±50ml). There was no significant modification of RV strain 72 hours after BMV (-15±%4 vs -16±4% with P=0.3). On multivariate analysis, mitral area and LV end-diastolic (LVED) volume were independently correlated with baseline GLS. The mitral area was a risk factor p=0.004 and LV end-diastolic volume was a protector factor P=0.007, whereas increment in LVED volume was the only determinant of increased GLS after BMV (P=0.049). Conclusions: LV and RV deformations are reduced in patients with severe MS and is related to the severity of the stenosis. LV GLS appears to be useful in the detection of subclinical LV systolic dysfunction in patients with MS and preserved ejection fraction. BMV results in rapid improvement of LV deformation which is correlated with serial improvement in LV diastolic loading, but not in the RV deformation. Further studies should be undertaken with longer follow-up to assess the improvement of RV function. MODERATED POSTER SESSION
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