{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T18:32:46Z","timestamp":1786559566708,"version":"build-2736575974"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"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":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Paravalvular leaks (PVLs) are common complications following prosthetic valve implantation, significantly impacting patient outcomes due to associated heart failure and hemolysis. While percutaneous closure is a recognized alternative to surgery, challenging anatomies and multiple leaks can be difficult to manage with traditional single\u2010access techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We present a case of a patient with a mechanical mitral prosthesis and two clinically significant mitral PVLs\u2014one anterior and one posterolateral. The patient presented with symptoms of heart failure and was experiencing transfusion\u2010dependent hemolytic anemia. To address the PVLs, we employed a dual\u2010access strategy. We used a standard transseptal anterograde approach to close the anterior PVL and a retrograde transfemoral arterial approach to close the larger posterolateral defect. Two dedicated PVLs occlude devices were successfully implanted without impacting the motion of the prosthetic leaflets. The total procedural time was 95\u2009min, comprising 38\u2009min of fluoroscopy and a total iodinated contrast volume of 120\u2009mL. Fortunately, no periprocedural complications occurred. Upon follow\u2010up, the patient demonstrated sustained clinical improvement, with resolution of hemolysis and only a trivial residual mitral PVL observed on echocardiography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The DASH approach combines two access routes to overcome the limitations of traditional single\u2010access methods. By using the Venturi effect, we simplify the procedure, improve device maneuverability, and increase success rates, even in complex cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In selected patients with multiple, anatomically complex mitral PVLs\u2014particularly when catheter alignment, stability, or prosthetic leaflet interaction limits a single\u2010access approach, a planned dual\u2010access strategy may represent a complementary technical option to facilitate safe device delivery. Larger series and longer follow\u2010up are needed to define the indications, safety profile, and durability of the DASH approach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70616","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T09:54:48Z","timestamp":1777024488000},"page":"183-188","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["DASH Closure: A Dual Access Strategy for Hemodynamic Closure of Mitral Paravalvular Leaks"],"prefix":"10.1002","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7715-6941","authenticated-orcid":false,"given":"Francesca","family":"Coppi","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults University of Modena and Reggio Emilia Modena Italy"},{"name":"National Institute for Cardiovascular Research (INRC) Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7067-279X","authenticated-orcid":false,"given":"Gianluca","family":"Pagnoni","sequence":"additional","affiliation":[{"name":"Cardiology Unit of Emergency Department Guglielmo da Saliceto Hospital Piacenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Arrotti","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5377-729X","authenticated-orcid":false,"given":"Susan","family":"Darroudi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults University of Modena and Reggio Emilia Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Galasso","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irma","family":"Marconi","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Stefani","sequence":"additional","affiliation":[{"name":"Intesivist Senior Consulting, InfectiousDesease University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cosmo","family":"Godino","sequence":"additional","affiliation":[{"name":"Clinical Cardiology Unit, Faculty of Medicine, IRCCS San Raffaele Scientific Institute Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2940-2455","authenticated-orcid":false,"given":"Antonio","family":"Colombo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University Pieve Emanuele\u2010Milan Italy"},{"name":"Cardio Center, IRCCS Humanitas Research Hospital Rozzano\u2010Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Oreglia","sequence":"additional","affiliation":[{"name":"De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1487-9530","authenticated-orcid":false,"given":"Anna Vittoria","family":"Mattioli","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC) Bologna 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