Hemodynamic guidance of mitral paravalvular leak closure: The V is the key

Key Points

• Severe mitral paravalvular leak (PVL) induces elevated mean left atrial (LA) pressure (LAP) and prominent V waves, leading to pulmonary hypertension and right heart failure
• PVL closure promptly reduces V wave and mean LAP, correlates with improved echo regurgitation grade, and exerts immediate benefit to the lungs and right heart
• Hemodynamic response patterns facilitate PVL closure

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