Percutaneous Mitral and Tricuspid Valves Repair, with the Mitraclip® System, Followed by Immediate Closure of Iatrogenic Atrial Septal Defect with Right-To-Left Shunt-A Case Report

A 64-year-old man was hospitalized several times, over the last year, with decompensated heart failure episodes.

Baseline Echocardiography demonstrated severe bi-ventricular dysfunction and severe functional both mitral (MV) and tricuspid (TV) regurgitation. He was deemed at extreme surgical risk and referred to transcatheter edge-to-edge Mitral and tricuspid repair.

First, The MV was treated with one NTR clip placed in the A2-P2 segment with acute reduction in MR to mild. Upon retraction of the guide from the left to the right atrium significant right-to-left shunt developed with hypoxemia and hypotension. immediately a balloon was inflated across the iASD with instant obliteration of the shunt. The TV was then treated with one XTR clip placed in the antero-septal commissure with acute reduction in TR to mild. However, once the balloon was deflated, bidirectional shunt was noted. Therefore, the iatrogenic atrial septal defect (iASD) was closed with a dedicated closure device.

The patient had an uncomplicated post procedural course. Pre-discharge echo demonstrated minimal MR , mild TR and no shunt across the atrial septum. he was discharged in stable condition.

At one-month follow-up clinical improvement was sustained with patient having no need for IV diuretics and having no hospitalization for heart failure symptoms.

Conclusion: We advise routine simultaneous real-time both LA and RA pressure monitoring during MC procedure. acute right-to-left shunt, although rare, can be anticipated and should be treated promptly.