BACKGROUND: Rapid deployment aortic valve replacement (RDAVR) has been widely adopted, but concerns about postoperative paravalvular leak (PVL) associated with its use remain. PVL is linked to an increased risk of long-term mortality
however, there is no consensus on its treatment. CASE PRESENTATION: Case 1: A 76-year-old female with severe aortic stenosis underwent RDAVR via median sternotomy. Intraoperative transesophageal echocardiography (TEE) revealed moderate PVL at the left-noncoronary cusp commissure. Three horizontal mattress stitches were applied from outside the aorta through the prosthetic sewing cuff to address the PVL site
however, the leak persisted. It was noted that the balloon-expandable sealing frame was slightly protruding inward at a location corresponding to the PVL site. Accordingly, balloon dilatation was performed under direct vision, and the PVL resolved. Postoperatively, no conduction disorders were observed. At the 24-month follow-up, echocardiography showed no recurrence of PVL. Case 2: A 78-year-old male with severe aortic stenosis underwent RDAVR in a standardized fashion. Intraoperative TEE revealed moderate PVL at the right coronary cusp side. The balloon-expandable sealing frame was found not to have fully expand outward at the PVL site. Balloon dilatation was therefore performed as in Case 1, successfully resolving the PVL. No postoperative conduction disorder was encountered. At the 12-month follow-up, echocardiography revealed no recurrent PVL. CONCLUSIONS: Direct intraoperative re-ballooning is a potentially effective option for addressing intraoperatively identified PVL after RDAVR.