Background: A 49-year-old female presented with worsening exertional dyspnea (NYHA class III) and orthopnea for several months. Previous medical history was significant for rheumatic mitral regurgitation and three previous mitral valve replacements (MVRs).
Investigation: Transesophageal echocardiography (TEE) revealed severe mitral paravalvular leak (PVL with two jets visualised. Cardiac computed tomography angiography (CTA) revealed a larger PVL and a smaller defect.
Diagnosis: Severe mitral paravalvular leak.
Treatment: Transcatheter mitral paravalvular closure.