Percutaneous Hybrid Approach for an Aortic Paravalvular Leak Associated With a Large Pseudoaneurysm

Background: Closure of complex paravalvular leak (PVL) via percutaneous approach may be challenging. Case Summary: Our case highlights the rare occurrence of a complex PVL that extended into a pseudoaneurysm with entry sites in the aorta and left ventricular outflow tract far apart. We performed a hybrid percutaneous approach with transapical closure of the left ventricular side and then retrograde transfemoral closure of the aortic side. Discussion: Patients treated surgically for infective endocarditis may exhibit postoperative changes, including the potential development of PVL. Weakening of the tissue in the tract may lead to aneurysmal growth. Percutaneous single-site exclusion would lead to incomplete treatment; hence, dual-entry closure (aortic and left ventricular outflow tract) is necessary to reduce PVL and prevent aneurysmal expansion. Take-Home Messages: This case explores the complexities of treating PVL associated with a long and serpiginous tract with aneurysmal growth. Single-site transcatheter exclusion is inadequate to reduce regurgitation and mitigate aneurysmal expansion for serpiginous PVL tracts associated with pseudoaneurysm.