Does the Morphology of Mitral Paravalvular Leaks Influence Symptoms and Hemolysis?
Michele Genoni MD, Daniel Franzen MD, Reza Tavakoli MD, Burkardt Seiffert MD, Kirk Graves MD, Rolf Jenni MD, Marko Turina MD

The morphology, size, location and number of primary paravalvular leaks were analyzed in 96 consecutive patients. Mitral leak was diagnosed a median of 119 days after primary mitral valve replacement (MVR). A small (1-2 mm) paravalvular leak was found in 41 patients, an intermediate leak (3-5 mm) in 26, and a large leak (6-15 mm) in 29. Single leaks were observed in 70 patients. Leaks were seen predominantly around the mitral commissural areas. The larger the size of the leak, the more symptomatic the patient. The number of leaks was not correlated with severity of clinical symptoms. Multiple leaks were more likely to cause significant hemolysis. Strict monitoring of all MVR patients is therefore necessary in the operating room, to detect possible technical errors and early leaks. As the location and size of the leaks were significantly surgeon-dependent, self-monitoring should be mandatory for all surgeons.