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Prison Break: Extraction of a Plug Jailed Between Two Mechanical Valves.

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Title: Prison Break: Extraction of a Plug Jailed Between Two Mechanical Valves.
Authors: Chaddad R; Department of Cardiology, Grand Hopital de l'Est Francilien, Jossigny, France., Elhadad S; Department of Cardiology, Grand Hopital de l'Est Francilien, Jossigny, France., Caussin C; Department of Cardiology, Institut Mutualiste Montsouris, Paris, France., Hakim M; Department of Cardiology, Grand Hopital de l'Est Francilien, Jossigny, France., Sfeir M; Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.
Source: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2026 Aug; Vol. 108 (2), pp. 596-601. Date of Electronic Publication: 2026 Jun 10.
Publication Type: Case Reports; Journal Article
Language: English
Journal Info: Publisher: Wiley-Liss Country of Publication: United States NLM ID: 100884139 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1522-726X (Electronic) Linking ISSN: 15221946 NLM ISO Abbreviation: Catheter Cardiovasc Interv Subsets: MEDLINE
Imprint Name(s): Original Publication: New York, NY : Wiley-Liss, c1999-
MeSH Terms: Foreign-Body Migration*/etiology , Foreign-Body Migration*/therapy , Foreign-Body Migration*/diagnostic imaging , Foreign-Body Migration*/physiopathology , Foreign-Body Migration*/surgery , Heart Valve Prosthesis Implantation*/adverse effects , Heart Valve Prosthesis Implantation*/instrumentation , Device Removal*/methods , Cardiac Catheterization*/instrumentation , Mitral Valve Insufficiency*/etiology , Mitral Valve Insufficiency*/physiopathology , Mitral Valve Insufficiency*/therapy , Mitral Valve Insufficiency*/diagnostic imaging , Mitral Valve Insufficiency*/surgery , Mitral Valve*/surgery , Mitral Valve*/physiopathology , Mitral Valve*/diagnostic imaging , Aortic Valve*/surgery , Aortic Valve*/physiopathology , Aortic Valve*/diagnostic imaging , Heart Valve Prosthesis* , Prosthesis Failure*, Pulmonary Edema/etiology ; Pulmonary Edema/therapy ; Heart Failure/etiology ; Heart Failure/physiopathology ; Humans ; Female ; Adult ; Treatment Outcome ; Prosthesis Design ; Echocardiography, Transesophageal ; Hemodynamics ; Recurrence
Abstract: Paravalvular leak (PVL) occurs in up to 17% of prosthetic valve replacements, mainly in the mitral position. Surgery is the gold standard but carries high morbidity in patients with a history of previous sternotomies. Transcatheter closure of PVL offers a minimally invasive alternative with a very high success rate. Device migration, while uncommon, can be catastrophic when impinging on mechanical prosthetic valve performance. We report the case of a 37-year-old woman with prior mechanical mitral and aortic valve replacements, complicated by recurrent heart failure due to a mitral PVL resulting from suture dehiscence. Initial transcatheter closure with two Amplatzer Vascular Plug III devices achieved a substantial reduction of regurgitation. Four months later, she presented with acute pulmonary edema caused by migration of one device into the left ventricular outflow tract, intermittently obstructing a mechanical aortic valve leaflet. Given her prohibitive surgical risk, percutaneous retrieval was undertaken, followed by immediate re-closure of the PVL during the same procedure, successfully restoring valve function and hemodynamic stability. This case illustrates the complexity of late PVL management after mechanical mitral valve replacement and highlights the potential risk of device migration. While surgery remains the gold standard, percutaneous intervention represents the only viable option in patients at prohibitive surgical risk. To our knowledge, this is the first reported case of successful percutaneous retrieval of an embolized device through a mechanical prosthesis, followed by re-closure of the PVL within the same procedure. This experience underscores the feasibility of advanced bailout strategies in carefully selected patients.
(© 2026 Wiley Periodicals LLC.)
References: Ann Thorac Surg. 2015 Oct;100(4):1347-52. (PMID: 26163972)
Catheter Cardiovasc Interv. 2007 Nov 15;70(6):815-23. (PMID: 18022905)
Eur Heart J. 2017 Sep 21;38(36):2739-2791. (PMID: 28886619)
Circulation. 2009 Feb 24;119(7):1034-48. (PMID: 19237674)
J Am Coll Cardiol. 2011 Nov 15;58(21):2210-7. (PMID: 22078427)
JACC Cardiovasc Interv. 2019 Jan 28;12(2):113-126. (PMID: 30678792)
J Am Soc Echocardiogr. 2017 Apr;30(4):303-371. (PMID: 28314623)
Eur J Cardiothorac Surg. 2006 Dec;30(6):887-91. (PMID: 17081767)
Circulation. 2016 Sep 27;134(13):934-44. (PMID: 27587432)
JACC Cardiovasc Interv. 2010 Jul;3(7):759-65. (PMID: 20650438)
Eur J Cardiothorac Surg. 2000 Jan;17(1):14-9. (PMID: 10735406)
JACC Cardiovasc Imaging. 2015 Oct;8(10):1191-1208. (PMID: 26481845)
Heart. 2003 Nov;89(11):1316-21. (PMID: 14594888)
EuroIntervention. 2020 Feb 20;15(14):1251-1259. (PMID: 31422926)
Entry Date(s): Date Created: 20260610 Date Completed: 20260803 Latest Revision: 20260813
Update Code: 20260813
PubMed Central ID: PMC13432656
DOI: 10.1002/ccd.70686
PMID: 42271187
Database: MEDLINE
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Paravalvular leak (PVL) occurs in up to 17% of prosthetic valve replacements, mainly in the mitral position. Surgery is the gold standard but carries high morbidity in patients with a history of previous sternotomies. Transcatheter closure of PVL offers a minimally invasive alternative with a very high success rate. Device migration, while uncommon, can be catastrophic when impinging on mechanical prosthetic valve performance. We report the case of a 37-year-old woman with prior mechanical mitral and aortic valve replacements, complicated by recurrent heart failure due to a mitral PVL resulting from suture dehiscence. Initial transcatheter closure with two Amplatzer Vascular Plug III devices achieved a substantial reduction of regurgitation. Four months later, she presented with acute pulmonary edema caused by migration of one device into the left ventricular outflow tract, intermittently obstructing a mechanical aortic valve leaflet. Given her prohibitive surgical risk, percutaneous retrieval was undertaken, followed by immediate re-closure of the PVL during the same procedure, successfully restoring valve function and hemodynamic stability. This case illustrates the complexity of late PVL management after mechanical mitral valve replacement and highlights the potential risk of device migration. While surgery remains the gold standard, percutaneous intervention represents the only viable option in patients at prohibitive surgical risk. To our knowledge, this is the first reported case of successful percutaneous retrieval of an embolized device through a mechanical prosthesis, followed by re-closure of the PVL within the same procedure. This experience underscores the feasibility of advanced bailout strategies in carefully selected patients.<br /> (© 2026 Wiley Periodicals LLC.)
– Name: Ref
  Label: References
  Group: RefInfo
  Data: Ann Thorac Surg. 2015 Oct;100(4):1347-52. (PMID: <searchLink fieldCode="PM" term="%2226163972%22">26163972)</searchLink><br />Catheter Cardiovasc Interv. 2007 Nov 15;70(6):815-23. (PMID: <searchLink fieldCode="PM" term="%2218022905%22">18022905)</searchLink><br />Eur Heart J. 2017 Sep 21;38(36):2739-2791. (PMID: <searchLink fieldCode="PM" term="%2228886619%22">28886619)</searchLink><br />Circulation. 2009 Feb 24;119(7):1034-48. (PMID: <searchLink fieldCode="PM" term="%2219237674%22">19237674)</searchLink><br />J Am Coll Cardiol. 2011 Nov 15;58(21):2210-7. (PMID: <searchLink fieldCode="PM" term="%2222078427%22">22078427)</searchLink><br />JACC Cardiovasc Interv. 2019 Jan 28;12(2):113-126. (PMID: <searchLink fieldCode="PM" term="%2230678792%22">30678792)</searchLink><br />J Am Soc Echocardiogr. 2017 Apr;30(4):303-371. (PMID: <searchLink fieldCode="PM" term="%2228314623%22">28314623)</searchLink><br />Eur J Cardiothorac Surg. 2006 Dec;30(6):887-91. (PMID: <searchLink fieldCode="PM" term="%2217081767%22">17081767)</searchLink><br />Circulation. 2016 Sep 27;134(13):934-44. (PMID: <searchLink fieldCode="PM" term="%2227587432%22">27587432)</searchLink><br />JACC Cardiovasc Interv. 2010 Jul;3(7):759-65. (PMID: <searchLink fieldCode="PM" term="%2220650438%22">20650438)</searchLink><br />Eur J Cardiothorac Surg. 2000 Jan;17(1):14-9. (PMID: <searchLink fieldCode="PM" term="%2210735406%22">10735406)</searchLink><br />JACC Cardiovasc Imaging. 2015 Oct;8(10):1191-1208. (PMID: <searchLink fieldCode="PM" term="%2226481845%22">26481845)</searchLink><br />Heart. 2003 Nov;89(11):1316-21. (PMID: <searchLink fieldCode="PM" term="%2214594888%22">14594888)</searchLink><br />EuroIntervention. 2020 Feb 20;15(14):1251-1259. (PMID: <searchLink fieldCode="PM" term="%2231422926%22">31422926)</searchLink>
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        Value: 10.1002/ccd.70686
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        Text: English
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        StartPage: 596
    Subjects:
      – SubjectFull: Pulmonary Edema etiology
        Type: general
      – SubjectFull: Pulmonary Edema therapy
        Type: general
      – SubjectFull: Heart Failure etiology
        Type: general
      – SubjectFull: Heart Failure physiopathology
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      – SubjectFull: Treatment Outcome
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        Type: general
      – SubjectFull: Echocardiography, Transesophageal
        Type: general
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      – SubjectFull: Foreign-Body Migration etiology
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      – SubjectFull: Foreign-Body Migration physiopathology
        Type: general
      – SubjectFull: Foreign-Body Migration surgery
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      – SubjectFull: Heart Valve Prosthesis Implantation adverse effects
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      – SubjectFull: Heart Valve Prosthesis Implantation instrumentation
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      – SubjectFull: Device Removal methods
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      – SubjectFull: Cardiac Catheterization instrumentation
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      – SubjectFull: Mitral Valve Insufficiency etiology
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      – SubjectFull: Mitral Valve diagnostic imaging
        Type: general
      – SubjectFull: Aortic Valve surgery
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        Type: general
      – SubjectFull: Aortic Valve diagnostic imaging
        Type: general
      – SubjectFull: Heart Valve Prosthesis
        Type: general
      – SubjectFull: Prosthesis Failure
        Type: general
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      – TitleFull: Prison Break: Extraction of a Plug Jailed Between Two Mechanical Valves.
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              Text: 2026 Aug
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              Y: 2026
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