Mitral paravalvular leak: Caution in percutaneous occluder device deployment

A frail 70-year-old woman presented with symptomatic mitral paravalvular leak 2 months after undergoing a double valve replacement for mixed mitral and aortic valve disease. There was no evidence of prosthetic valve endocarditis. Percutaneous closure of the paravalvular leak was attempted as an alternative to a high-risk surgical procedure. This therapy was successful in reducing the regurgitation but resulted in severe intravascular hemolysis and acute renal failure requiring hemodialysis. The development of new hemolysis and acute renal failure directed our attention to the Amplatzer device as a possible etiology for these complications. The assumption that her kidney injury was recent and likely reversible compelled us to think of the surgical method as a definitive option. A re-operative surgery was performed, which included retrieval of the occluder devices, pericardial patch repair, and re-replacement using a new biological prosthesis. The patient's urine output gradually improved, and the patient was dismissed with normal renal function. We present this case as an unusual complication of percutaneous device closure. It also highlights the reversible nature of acute renal failure due to intravascular hemolysis and demonstrates the importance of early surgical intervention for this condition.