Resolution of severe hemolysis and paravalvular aortic regurgitation employing an Amplatzer Vascular Plug 4: the importance of detailed pre-procedural planning using CT angiography.

A 76-year-old woman presented with progressive heart failure and transfusion-dependent hemolytic anemia due to severe paravalvular aortic regurgitation 4 years after bioprosthetic aortic valve replacement. She was deemed not to be a candidate for redo cardiac surgery due to a porcelain aorta and multiple comorbid medical conditions. We describe the role of pre-procedure contrast-enhanced, ECG-gated computed tomographic angiography to characterize the anatomy of the paravalvular leak connection for appropriate occluder device selection leading to successful percutaneous closure and resolution of the paravalvular regurgitation and hemolytic anemia.