Left main coronary artery embolization after transcatheter paravalvular leak closure

This is the case of a 72-year-old man with mitral and aortic mechanical prosthetic valves, chronic kidney disease, and severe pulmonary hypertension. In 2019, a mitral anterolateral paravalvular leak (PVL) was percutaneously closed with implantation of 2 devices (the AVP III 10 mm x 5 mm, and the AVP III 8 mm x 4 mm, St Jude Medical, United States) due to heart failure. The patient’s clinical progression was favorable with moderate mitral regurgitation. One year later, the patient’s symptoms worsened, and the transesophageal echocardiogram performed revealed severe mitral regurgitation due to recurrent PVL around the devices (figure 1A). A second percutaneous closure attempt was scheduled to close the PVL. The initial procedure was to implant another device next to the other devices, but they embolized into the left ventricle when the deflectable catheter touched them (figure 1B). They were captured using a gooseneck loop snare through the PVL and then retrieved using 2 sheaths in the left atrium (figure 1C). Two hours later, the patient developed hemodynamic instability, and ST-segment elevation. An emergency coronary angiogram revealed the presence of severe stenosis in the left main coronary artery (LMCA) that was not present in the previous angiogram (figure 1D). The...