Multiple paravalvular leak 17 years after a second mitral valve replacement

Paravalvular leak (PVL) after prosthetic valve implantation is a significant complication and it usually occurs early in the postoperative period. We report a case of multiple PVL 17 years after the second mitral valve replacement without evidence of infection. The valve sutures were neither cut nor loosened. None of the sewing cuff of the mitral valve was covered with fibrous tissue. The sewing cuff was floated over the native annulus and large and multiple leakage was developed. The valve was easily removed and replaced with a new mechanical prosthesis.