Iatrogenic Atrial Septal Defect Closure Following Mitral Transcatheter Edge-to-Edge Repair

Abstract

Transcatheter edge-to-edge repair has revolutionized the management of mitral regurgitation in the high surgical-risk population. Iatrogenic atrial septal defects (iASDs) are an obligatory consequence of the procedure. The long-term sequelae of persistent iASDs are unknown but are believed to be dependent on their size, directionality of flow, and underlying hemodynamics. We discuss an uncommon scenario of a post–transcatheter edge-to-edge repair iASD that required immediate closure. ( Level of Difficulty: Intermediate. )

Percutaneous closure of the iatrogenic atrial septal defect following the transcatheter edge-to-edge mitral valve repair with MitraClip system led to instant improvement of hypoxemia — case report

“…The most common indication for iASD closure, reported in 17 cases (57% of all performed procedures), was an acute deterioration of a patient due to hypoxemia with right-to-left blood flow, as described also in the presented manuscript [22]. Similar clinical scenarios were also described in other previously published case reports [12,16,23].…”

“…Nevertheless, previous studies showed a decreased rate of persistent iASD over time suggesting spontaneous closure in most of the patients [10]. The clinical importance of the persistence of iASD after a transseptal puncture is being increasingly discussed and up to date the optimal management in those patients remains not clear [11][12][13]. Still little is known regarding the haemodynamic and clinical consequences of persistent iASDs in the long-term perspective, therefore routine closure is not a common practice after the TEER procedure [13][14][15].…”

Iatrogenic Atrial Septal Defect After MitraClip Transcatheter Edge-to-Edge Repair: To Close or Not to Close?

“… 2 Mitral valve repair is advised when clinical symptoms and moderate to severe mitral valve regurgitation persist despite GDMT. 3 Over the past 10 years, TEER has evolved as an alternative for replacing mitral valves in patients for whom open heart surgery would be high risk. The evolution of percutaneous procedures that use transseptal puncture to treat left-sided structural heart disease, however, has led to the emergence of iASD, a potential complication that can induce hemodynamic decompensation that worsens clinical outcomes.…”

The importance of pre‐ablation atrial septal evaluation for a patient with surgical patch closure history

“…We utilized the peri‐patch leak for transeptal access to avoid difficulty in penetration of the ASD patch. Preoperative imaging should be conducted to evaluate the effect of the needle puncture around the artificial material of the atrial septum and catheter manipulation should be considered 4 . The transseptal approach is increasingly used for the catheterization of valvular diseases and atrial fibrillation.…”

“…Preoperative imaging should be conducted to evaluate the effect of the needle puncture around the artificial material of the atrial septum and catheter manipulation should be considered. 4 The transseptal approach is increasingly used for the catheterization of valvular diseases and atrial fibrillation. Furthermore, the evolution of a variety of interventions including the transseptal approach necessitates attention to the importance of site-specific transseptal access, 3 Here, we reported a case of ASD, detected by preoperative TTE and cardiac CT, where a transseptal approach via minor peri-closure patch leak was used.…”