Impact of percutaneous mitral paravalvular leak closure on the natural history of recurrent gastrointestinal bleeding

Valvular heart disease and gastrointestinal bleeding (GIB) due to angiodysplasia have a well-established link with aortic stenosis, where GIB is believed to be mediated by increased shear stress and acquired von Willebrand (VW) syndrome12. Platelet dysfunction and VW factor abnormalities are less commonly described in mitral regurgitation3 and in dysfunctional valve prostheses4. In these cases, valve replacement frequently solves abnormalities in primary haemostasis14. Little is known about the relationship between mitral paravalvular leaks (PVL) and GIB due to angiodysplasia and whether PVL closure affects the natural history of GIB in these patients. We hypothesised that high velocity jets through the PVL orifice could induce gastrointestinal bleeding due to intestinal angiodysplasia that may otherwise improve if PVL closure is achieved (Figure 1A).

To assess the relationship between PVL and GIB, we included in our study all percutaneous closures of mitral PVL performed in symptomatic patients at a tertiary referral centre between January 2010 and November 2022. Follow-up was completed in May 2023. Redo procedures were not included. To assess the impact of procedural success...