TY - JOUR
T1 - Iatrogenic atrial septal closure for mitral stenosis after transcatheter edge-to-edge repair
T2 - A case report
AU - Tanaka, Shuhei
AU - Ueno, Hiroshi
AU - Fukuda, Nobuyuki
AU - Imamura, Teruhiko
AU - Kinugawa, Koichiro
N1 - Publisher Copyright:
© 2024 Elsevier Ltd
PY - 2024/11
Y1 - 2024/11
N2 - Interventions for structural heart disease requiring a transvenous and transseptal approach, such as transcatheter edge-to-edge repair (TEER), cause iatrogenic atrial septal defect (IASD) after treatment. Its clinical impact remains uncertain. We present the case of an 84-year-old female patient with heart failure with preserved ejection fraction and stress-induced mitral regurgitation (MR), who was repeatedly hospitalized for acute pulmonary edema. Exercise stress echocardiography reproduced worsening MR. Intervention for MR by TEER was considered, while small mitral valve area was a concern. Mitral stenosis (MS) occurred at the time of TEER, but the clip was eventually implanted to prioritize improvement of regurgitation. IASD was subsequently a concern, as the volume of the left-to-right shunt was increasing, and cardiac output was decreasing. We decided to perform a percutaneous IASD closure, which successfully elevated her blood pressure and allowed her to be discharged home on foot. The coexistence of MS, as in the present case, may increase the negative hemodynamic impact of IASD. Percutaneous IASD closure may be a promising therapeutic strategy to stabilize hemodynamics in carefully selected cases. Learning objective: Iatrogenic atrial septal defect (IASD) closure is rarely necessary after transcatheter edge-to-edge repair (TEER). Excessively narrowing mitral valve area after TEER can increase the hemodynamic impact of left-to-right shunt flow through IASD. IASD closure may increase cardiac output, but the indication should be carefully determined after confirming the hemodynamic impact, e.g. balloon closure studies.
AB - Interventions for structural heart disease requiring a transvenous and transseptal approach, such as transcatheter edge-to-edge repair (TEER), cause iatrogenic atrial septal defect (IASD) after treatment. Its clinical impact remains uncertain. We present the case of an 84-year-old female patient with heart failure with preserved ejection fraction and stress-induced mitral regurgitation (MR), who was repeatedly hospitalized for acute pulmonary edema. Exercise stress echocardiography reproduced worsening MR. Intervention for MR by TEER was considered, while small mitral valve area was a concern. Mitral stenosis (MS) occurred at the time of TEER, but the clip was eventually implanted to prioritize improvement of regurgitation. IASD was subsequently a concern, as the volume of the left-to-right shunt was increasing, and cardiac output was decreasing. We decided to perform a percutaneous IASD closure, which successfully elevated her blood pressure and allowed her to be discharged home on foot. The coexistence of MS, as in the present case, may increase the negative hemodynamic impact of IASD. Percutaneous IASD closure may be a promising therapeutic strategy to stabilize hemodynamics in carefully selected cases. Learning objective: Iatrogenic atrial septal defect (IASD) closure is rarely necessary after transcatheter edge-to-edge repair (TEER). Excessively narrowing mitral valve area after TEER can increase the hemodynamic impact of left-to-right shunt flow through IASD. IASD closure may increase cardiac output, but the indication should be carefully determined after confirming the hemodynamic impact, e.g. balloon closure studies.
KW - Heart failure
KW - Iatrogenic atrial septal defect
KW - Mitral regurgitation
UR - http://www.scopus.com/inward/record.url?scp=85199474681&partnerID=8YFLogxK
U2 - 10.1016/j.jccase.2024.07.002
DO - 10.1016/j.jccase.2024.07.002
M3 - 学術論文
C2 - 39534311
AN - SCOPUS:85199474681
SN - 1878-5409
VL - 30
SP - 150
EP - 153
JO - Journal of Cardiology Cases
JF - Journal of Cardiology Cases
IS - 5
ER -