Vol 7, No 4 (2022)
Case report
Published online: 2022-12-14

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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

Jakub Marcin Ratajczak12, Adam Sukiennik2, Marek Woźnicki2, Jacek Kubica2
Medical Research Journal 2022;7(4):350-354.

Abstract

Transcatheter edge-to-edge mitral valve repair (TEER) is an established alternative for patients with severe, symptomatic mitral regurgitation (MR) at high surgical risk. The TEER procedure requires transseptal access, therefore might lead to the development of persistent iatrogenic atrial septal defect (iASD). The clinical significance of iASD and optimal management particularly from a long-term perspective is not clear. Herein, we described a case report of a 76-year-old female with prior left atrial appendage occlusion and severe MR that underwent a TEER procedure using MitraClip® (MC) system. After the MC implantation, she developed acute hypoxemia due to interatrial right-to-left shunt and required immediate iASD closure.

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References

  1. Iung B, Delgado V, Rosenhek R, et al. EORP VHD II Investigators. Contemporary presentation and management of valvular heart disease: the eurobservational research programme valvular heart disease II survey. Circulation. 2019; 140(14): 1156–1169.
  2. Ratajczak J, Sukiennik A, Sielski S, et al. Successful reduction of severe mitral regurgitation after implantation of four MitraClip devices. Medical Research Journal. 2016; 3(4): 176–179.
  3. Vahanian A, Beyersdorf F, Praz F, et al. ESC/EACTS Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022; 43(7): 561–632.
  4. Feldman T, Wasserman H, Herrmann H, et al. Percutaneous mitral valve repair using the edge-to-edge technique. J Am Coll Cardiol. 2005; 46(11): 2134–2140.
  5. Feldman T, Kar S, Elmariah S, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation. J Am Coll Cardiol. 2015; 66(25): 2844–2854.
  6. Sorajja P, Vemulapalli S, Feldman T, et al. Outcomes with transcatheter mitral valve repair in the united states: an STS/ACC TVT registry report. J Am Coll Cardiol. 2017; 70(19): 2315–2327.
  7. Stone GW, Lindenfeld J, Abraham WT, et al. COAPT Investigators. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018; 379(24): 2307–2318.
  8. Puls M, Lubos E, Boekstegers P, et al. One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registry. Eur Heart J. 2016; 37(8): 703–712.
  9. Ratajczak J, Jaworska E, Tomczak M, et al. Treatment of severe mitral regurgitation with MitraClip system — a single-centre study. Medical Research Journal. 2016; 1(2): 81–87.
  10. Schnitzler K, Hell M, Geyer M, et al. Complications following MitraClip implantation. Curr Cardiol Rep. 2021; 23(9): 131.
  11. Alkhouli M, Sarraf M, Holmes DR. Iatrogenic atrial septal defect. Circ Cardiovasc Interv. 2016; 9(4): e003545.
  12. Shetty M, Lampert MB, Levisay J, et al. Iatrogenic atrial septal defect closure following mitral transcatheter edge-to-edge repair: when do you close? JACC Case Rep. 2020; 3(3): 357–360.
  13. Kadado AJ, Islam A. Iatrogenic atrial septal defect following the MitraClip procedure: a state-of-the-art review. Catheter Cardiovasc Interv. 2021; 97(7): E1043–E1052.
  14. Blazek S, Unterhuber M, Rommel KP, et al. Biventricular physiology of iatrogenic atrial septal defects following transcatheter mitral valve edge-to-edge repair. JACC Cardiovasc Interv. 2021; 14(1): 54–66.
  15. Eden M, Leeb L, Frey N, et al. Haemodynamics of an iatrogenic atrial septal defect after MitraClip implantation. Eur J Clin Invest. 2020; 50(10): e13295.
  16. Chandraprakasam S, Satpathy R. When to close iatrogenic atrial septal defect after percutaneous edge to edge repair of mitral valve regurgitation. Cardiovasc Revasc Med. 2016; 17(6): 421–423.
  17. Ikenaga H, Hayashi A, Nagaura T, et al. Left atrial pressure is associated with iatrogenic atrial septal defect after mitral valve clip. Heart. 2019; 105(11): 864–872.
  18. Saitoh T, Izumo M, Furugen A, et al. Echocardiographic evaluation of iatrogenic atrial septal defect after catheter-based mitral valve clip insertion. Am J Cardiol. 2012; 109(12): 1787–1791.
  19. Schueler R, Öztürk C, Wedekind JA, et al. Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the MitraClip system: a note of caution. JACC Cardiovasc Interv. 2015; 8(3): 450–459.
  20. Toyama K, Rader F, Kar S, et al. Iatrogenic atrial septal defect after percutaneous mitral valve repair with the mitraclip system. Am J Cardiol. 2018; 121(4): 475–479.
  21. Smith T, McGinty P, Bommer W, et al. Prevalence and echocardiographic features of iatrogenic atrial septal defect after catheter-based mitral valve repair with the MitraClip system. Catheter Cardiovasc Interv. 2012; 80(4): 678–685.
  22. Takaya Y, Akagi T, Hara H, et al. Iatrogenic atrial septal defect requiring transcatheter closure following transcatheter mitral valve repair. Circ J. 2022; 86(11): 1740–1744.
  23. Masumoto A, Yamamoto H, Takahashi N, et al. A large iatrogenic tearing of atrial septal defect after MitraClip implantation: a rare and cautionary complication during transcatheter edge-to-edge mitral valve repair. Eur Heart J Case Rep. 2022; 6(4): ytac119.
  24. Hoffmann R, Altiok E, Reith S, et al. Functional effect of new atrial septal defect after percutaneous mitral valve repair using the MitraClip device. Am J Cardiol. 2014; 113(7): 1228–1233.
  25. Lurz P, Unterhuber M, Rommel KP, et al. Iatrogenic atrial septal defects following transcatheter mitral valve repair and implications of interventional closure. JACC Cardiovasc Interv. 2021; 14(24): 2685–2694.