lPar valv lar Leakage after lLeft Ir EnJlangement an lR.eo on? Ipek, vat Yalqrt of Ca snd treat valve be MVR 31..5 after d but certain isadvantages. Paravalvular leakage (PVr) complication after mitral valve ', and can impair cardiac function and red the t's functional capacity, depend- mg on of periprrosthetic regurgitation. .1985 arrd luly 1999,2,502 patients MVR ures. with or without concomitant car- cliac these patients, 33 (L8 males, L5 39.8 * 15.3 years; range: L2-62 differirag degree. The interval observation of PVL was 30.5 + 1-126 months), and the period 22.6 *:31.5 months (range:2-114 mean years) PVT, patients (42.47o) underwent reop- ), and 79 (57.6Vo) were followed (ME up). trndications for reoperation functional capacity, echocardio- serious mitra.l regurgitation, and hemol Results: mortality was 3.0% (1/33), and late i.ty 3.1. srurvival afrer ten A,nnul many aspects of prosthetic valve design and ique haLve improved over the past tlree late sequelae of periprosthetic to complicate the course in some Pa otherr,vise have undergone suc- replacement (MVR). Para ge (PVL) is a rare, but potentially cessful senous/ defined Address Kaan Kirali MD, Depa Kalp I Turkey fun of the stuily: Prostheses used to disease improve patient survival, (1132) f'or all patients. Cumulative was 90.2 + 6.7% at both five and calcification $3.A%) and infective of IVIVR (1-6). PVL may be :retrograde flow of blood ve : of Cardiovascular Surgery, Kosuyolu Hastanesi 81020, Kadik<iy, Istanbul, (9 Coirwiehr bv ICR Publishers 2001 Mitral \/alve Replacerrtent: Xs Additional Indication for yan lvlansuroglu, Bengi Yayqracil, Suat Na,il Onneroglu, Yelda Basaranl, iaaascular Surgery and lCardiology, Kfsuyolu Heart and Resenrch Hospital, Istanbul, nfi*eV endocarditis (Lll.2Tol were important predictive fac- tors for ,ilevelopment of PVL. Only one patient required seconrl re-do surgery. Univariate and for- ward stepwise logistic regression analyses showed that there was rno predictor for the development of severe PVL requiring a second reonreration. No dif- ference lvas o,bserved between left ventricular dirnensions before and #ter periprosthetic regurgi- tation. The onl1'significant finding between groups was an increase in left atrial diameter in RO patients after the dtevelopment of PVL (p <0.05). Conclusion: Among patients undergoing MVR there are no clinical feafures to distinguish who will develop sever€l PVL during follow up. If PVL reduces the patient's functional capacity or causes serious hr:molysis, or if severe PVL is evaluated echocardiographically, then reoperation must be per- formed. Mtild or moderate mitral regurgitation with- out impairment of functional capacity may be followed rnedically. In asymptomatic patients, enlargement (>STol of the left ahial diameter follow- ing development of moderate PVLmaybe avaluable criterion for deciding when to reoperate. The JournaLl of Heart Valve Disea se 2AA'I;7A:418-425 around tlLe cirr:umference of a prosthetic valve, between the sewing ring and the annulus of the native valve. Antecedent or active infection, annular calcifi- cation or extensi're debridement and delayed surgery increase the risk of late PVL. Echocardiography is the method of choice for detecting and followingPVL (7- 10), which can either begin acutely and cause severe symptoms, or remain as a small leak. The reinterven- tion for mild and moderate PVL without any symp- toms is currently under debate, as there are no criteria by which the nee,C for reintervention may be judged in these cases. Hence, these patients should be followed carefully vrith sr:rial clinical and echocardiographic examinafions.