{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:08:29Z","timestamp":1778825309619,"version":"3.51.4"},"reference-count":6,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Percutaneous mitral paravalvular leak (PVL) closure in patients with double mechanical valves presents substantial technical challenges when conventional transseptal antegrade approaches fail. Transapical puncture, while an alternative, carries significant risks including hemothorax and coronary injury. Safe and reliable left ventricular (LV) access without high\u2010risk transapical puncture remains a critical unmet need in complex structural heart interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 69\u2010year\u2010old woman with mechanical mitral and aortic valve replacements and persistent PVL despite prior percutaneous closure presented with recurrent heart failure symptoms. Transesophageal echocardiography demonstrated two moderate\u2010to\u2010severe PVL jets at the 7 o'clock position surrounding the previous occluder device. A Left Bundle Branch Area Pacing (LBBAP) delivery system was advanced from the left subclavian vein to create a controlled interventricular septal puncture under continuous unipolar pacing and electrocardiographic monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The LBBAP\u2010assisted interventricular septal crossing established a stable transventricular tract from right to left ventricle, enabling advancement of an 8.5\u2009Fr steerable sheath. A separate transseptal puncture provided left atrial access. A veno\u2010venous loop was created using a snare technique, facilitating deployment of two Amplatzer vascular plugs (8\u2009\u00d7\u20097\u2009mm AVP\u2010II and 12\u2009\u00d7\u20095\u2009mm AVP\u2010III) across the mitral PVL defects under transesophageal echocardiographic and fluoroscopic guidance. At follow\u2010up, she remained asymptomatic, with no residual ventricular septal flow on imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This first reported case of LBBAP\u2010assisted interventricular septal access for mitral PVL closure demonstrates feasibility and safety as an alternative when conventional approaches are not viable. This technique avoids transapical puncture risks and may expand therapeutic options for anatomically challenging structural heart interventions, particularly in patients with double mechanical valves (NCT07129122).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70509","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T05:42:09Z","timestamp":1771479729000},"page":"1682-1686","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Technique for Percutaneous Mitral Paravalvular Leak Closure: LBBAP Lead Assisted Ventricular Septal Way"],"prefix":"10.1002","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9681-2374","authenticated-orcid":false,"given":"Hasan","family":"Ari","sequence":"first","affiliation":[{"name":"Department of Cardiology Bursa Postgraduate Hospital Bursa Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3747-9580","authenticated-orcid":false,"given":"Ahmet","family":"T\u00fct\u00fcnc\u00fc","sequence":"additional","affiliation":[{"name":"Department of Cardiology Bursa Postgraduate Hospital Bursa Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selma","family":"Ari","sequence":"additional","affiliation":[{"name":"Department of Cardiology Bursa Postgraduate Hospital Bursa Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ay\u015fe Dilara","family":"Balyimez","sequence":"additional","affiliation":[{"name":"Department of Cardiology Bursa Postgraduate Hospital Bursa Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tahsin","family":"Bozat","sequence":"additional","affiliation":[{"name":"Department of Cardiology Bursa Postgraduate Hospital Bursa Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.repc.2020.07.013"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-822224-9.00010-4"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/24748706.2017.1353188"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2011.05.018"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.22586"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2025.02.036"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70509","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70509","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70509","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:19:27Z","timestamp":1778822367000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70509"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,18]]},"references-count":6,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/ccd.70509"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70509","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,18]]},"assertion":[{"value":"2025-10-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}