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Paravalvular leak occurs in 1–5% patients following surgical valve replacement and is associated with complications including haemolysis, heart failure and endocarditis. Re-do surgery is difficult with mortality rates approaching 16%. Percutaneous closure of mitral valve leaks with occluder devices is a viable alternative to repeat sternotomy; however, clinicians should be aware of contra-indications which include active endocarditis. Management of paravalvular leak is complex and success requires multi-disciplinary approach with cardiothoracic surgeons, clinical, imaging and interventional cardiologists.