Paravalvular leak (PVL) is a known complication of surgical and transcatheter valve replacement procedures. Patients most commonly present with congestive heart failure and/or hemolysis, and repeat surgical procedures to correct the PVL carries increased risk with reduced likelihood of success. As a result, percutaneous approaches to PVL closure have been developed, with a considerable emphasis on multimodality imaging for both diagnosis and procedural guidance in the cardiac catheterization laboratory. Several large series of percutaneous PVL closure have been recently published, with encouraging results with respect to both procedural success and clinical outcomes. Here, we give a comprehensive review of imaging and procedural techniques for percutaneous PVL closure and present the data supporting this novel treatment strategy.  (Circ J 2013; 77: 19–27)