Percutaneous transapical closure of cardiac apex with an ADO-II device after successful transapical transcatheter prosthetic mitral paravalvular leak closure

The transapical transcatheter approach for percutaneous interventions is performed in high-risk patients with peripheral vascular disease and when transseptal attempt failed. The apical access is traditionally performed through a left minithoracotomy at the fifth intercostal space under general anesthesia. But, there are some complications and risks like ventricular arrhythmias, ventricular tear and life-threatening surgical bleeding in the apical access even though it is a minimally invasive procedure [1]. Although new apical closure devices have been developed and tested in animals and humans, the apical closure remains a challenge in recent studies [2]. The cardiologists started to use the occluders to closure the percutaneous apical accesses [3–11]. We report a case of a successful percutaneous closure of the apical access with a 4 mm ADO-II device after a standard transapical mitral paravalvular leak closure procedure without minithoracotomy. A67year old femalewas admitted to our departmentwith severe dyspnea (NHYA classes II–III). And she had hemolytic anemia (hemoglobin level 9.0 g/dL, lactate dehydrogenase 1588 IU/L). She had a history of mitral bioprosthesis valve replacement in 1997 and metallic mitral valve replacement in 2005. Transesophageal echocardiography (TEE)