Percutaneous closure of a complex prosthetic mitral paravalvular leak using transesophageal echocardiographic guidance.

A 75-year-old man had a significant mitral paravalvular leak following unsuccessful mitral valve repair at age 71 years and mitral valve replacement two years later. He was referred for percutaneous closure, which was performed with an atrial septal defect occluder device. Subsequently, a small residual leak was closed with an embolization coil. A novel technique for identifying the paravalvular leak with simultaneous transesophageal and radiographic guidance is described.