Prosthetic mitral valve obstructed by occluder device for paravalvular leak.

70-year-old man, with the history of rheumatic Amitral valvulopathy, prosthetic mitral valve replacement, and two subsequent surgical reinterventions for infective endocarditis and paravalvular leak, presented with severe hemolytic anemia. Paravalvular leak of his prosthetic mitral valve was diagnosed. He received closure with two Amplatzer duct occluders and had symptomatic improvement. Unexpectedly, poor motion of the prosthetic valve was noted 5 months later. Multidetector-row computed tomography revealed closure of both leaflets of the mitral prosthesis in systole (Fig 1A; Ao 1⁄4 aorta; LA 1⁄4 left atrium; LV 1⁄4 left ventricle). During diastole (Fig 1B), one of the valve leaflets