Case Report: Moderate-to-severe paravalvular leak regurgitation after recurrent prosthetic valve endocarditis in a patient with a double-chambered right ventricle associated with a restricted membranous ventricular septal defect

Background: Managing aortic paravalvular leak (PVL) regurgitation following multiple surgical aortic valve replacements (SAVRs) due to recurrent infective endocarditis (IE) presents significant clinical challenges. Case summary: A 46-year-old woman with a history of severe aortic regurgitation and an asymptomatic membranous ventricular septal defect underwent SAVR with a bioprosthetic aortic valve (Perimount 23 mm) in 2005. Concomitantly, a double-chambered right ventricle was diagnosed. Ten years later, due to recurrent IE, another bioprosthetic valve replaced the previous valve (Magna Ease #25). In 2018, she developed sepsis from Bordetella hinzii endocarditis, leading to a third SAVR in 2019, this time with a mechanical aortic valve (On-X® #23). In 2024, two-dimensional transesophageal echocardiography (TEE) revealed moderate-to-severe PVL regurgitation near the right coronary cusp. After a multidisciplinary evaluation, transcatheter PVL closure was planned. Under general anesthesia and TEE/angio-fluoroscopic guidance, the PVL was successfully crossed via the right femoral artery, and a 10 mm × 4 mm Occlutech paravalvular leak device was deployed. Post-procedural imaging confirmed effective PVL closure with a trace-mild residual leak. Discussion: This case highlights the feasibility of transcatheter PVL closure as a less invasive alternative for patients with multiple prior SAVRs and high surgical risk. Advanced imaging techniques were crucial in procedural success, ensuring precise device placement. A multidisciplinary heart team approach is essential for optimizing outcomes in complex valve pathology. Long-term follow-up is necessary to monitor the durability of the closure and potential complications.