Key result
Combined transcatheter mitral repair and ASD closure relieves right heart failure in severe MR.
Why the study?
Chronic MR is common and carries poor outcomes, but concomitant ASDs are rare in the elderly and procedural planning for simultaneous transcatheter therapies remains complex.
Case Report (n=1)
Simultaneous transcatheter mitral valve repair and ASD closure is feasible and may improve right ventricular function and symptoms in complex, inoperable patients with severe MR and concomitant ASD.
Supports feasibility in select inoperable patients; leaves open need for prospective data on safety and outcomes.
BACKGROUND: Chronic mitral regurgitation (MR) is one of the most common valvular heart diseases and is associated with poor outcomes. Although other structural diseases are regularly seen in such patients, concomitant atrial septal defects (ASDs) remain a rarity in the elderly. CASE SUMMARY: We report a case of an 82-year-old woman with progressive right-sided heart failure (HF) due to MR and an ASD of secundum type, despite optimal medical therapy. Combined transcatheter mitral valve repair (MVR) by utilizing a separate transseptal puncture and ASD closure was performed resulting in amelioration of symptoms. DISCUSSION: Procedural planning for simultaneous transcatheter therapies of coupled structural heart disease entities remains complex. Our case illustrates feasibility of percutaneous edge-to-edge MVR and consecutive closure of a large secundum ASD. Different options of accessing the left atrium should be discussed on an individual basis, while additional ASD closure may be beneficial in terms of right ventricular function and symptoms of right HF.
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Barbieri et al. (2021) conducted a case report in Severe functional mitral regurgitation and secundum atrial septal defect (n=1). Combined transcatheter mitral valve repair and ASD closure was evaluated on Symptom amelioration and echocardiographic improvement. Combined transcatheter mitral valve repair and ASD closure was feasible and ameliorated right heart failure symptoms in an 82-year-old inoperable woman with severe MR and secundum ASD.
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