A percutaneous approach can be used to manage a leak adjacent to a prosthetic valve in carefully selected patients.
Criteria for successful closure:
(1) delivery of a reduction device free of mechanical prosthesis interference
(2) immediate regurgitation reduction >= 1 grade
Indications:
(1) high surgical risk
(2) NYHA functional class III or IV heart failure and persistent hemolytic anemia
(3) anatomic features suitable for percutaneous approach
Relative contraindications:
(1) performance at hospital not a center of excellence
(2) performance by a cardiologist with limited training (due to learning curve)
(3) percutaneous approach not suitable for anatomic features
Absolute contraindications:
(1) active endocarditis
(2) significant dehiscence (> 25% of valve ring)
