Muscular Ventricular Septal Defect Occluder

Symptomatic paraprosthetic leak can be treated with per-cutaneous transcatheter closure as an alternative to car-diac surgery. Dedicated devices are not yet available, but once the morphology of the leakage has been defined, it is possible to choose among the existing devices that are currently used for other percutaneous procedures.1–3 A 55-year-old woman presented with severe hemolytic anemia, jaundice, dyspnea, and recent recurrent bacterial endocarditis that was complicated by mitral prosthetic de-tachment. The patient’s clinical history was characterized by rheumatic mitral valvulopathy, for which she had been treated at the age of 33 years with prosthetic valve implantation, and 2 subsequent reinterventions of prosthetic mitral valve re-placement for thrombosis and endocarditis. Transesophageal echocardiogram showed a posterolateral leak (Figure 1 and Movies I and II). Because this would be her fourth reopera