Paravalvular leak closure in a Perceval-after-Mitroflow procedure

A 75-year-old female underwent aortic valve replacement with a sutureless Perceval valve due to degeneration of the Mitroflow aortic bioprosthesis. She was admitted 2 years later for heart failure. The transesophageal echocardiography (TEE) performed showed a class III-paravalvular leak (PVL) of the left coronary cusp probably due to calcification (figure 1A,B, video 1 and, video 2 of the supplementary data). Our heart team decided to perform percutaneous closure of the PVL