Key result
Percutaneous iASD closure rapidly resolves refractory hypoxemia from right-to-left shunting post-TEER.
Why the study?
Iatrogenic atrial septal defects routinely occur after transseptal puncture in TEER, but significant right-to-left shunting causing refractory hypoxemia is rare.
Case Report (n=1)
No
Severe hypoxemia following successful TEER should prompt immediate evaluation for a right-to-left shunt through an iatrogenic atrial septal defect, particularly in patients with anemia or those receiving mechanical ventilation with PEEP.
Answers are grounded in this paper and cite their sources.
May prompt iASD evaluation in refractory post-TEER hypoxemia; hypothesis-generating case report leaves open need for prospective studies.
Transcatheter Edge-to-Edge Repair (TEER) is an established therapy for high-surgical-risk patients with severe mitral regurgitation (MR). Iatrogenic atrial septal defects (iASD) are a routine consequence of transseptal puncture, and significant right-to-left shunting (RLS) causing refractory hypoxemia is rare. This report presents a man in his 80s with multiple comorbidities who underwent successful surgery. Despite procedural success confirmed by transesophageal echocardiography (TEE), the patient developed refractory hypoxemia during the early recovery phase while still undergoing mechanical ventilation. Normal airway pressures and partial pressure of end tidal carbon dioxide (PETCO 2 ) ruled out common pulmonary causes. Postoperative transthoracic echocardiography (TTE) revealed a right-to-left shunt via an iASD, which was promptly closed percutaneously, resulting in rapid resolution of hypoxemia. This report highlights that severe hypoxemia following successful TEER should trigger a suspicion of a RLS, especially in patients receiving mechanical ventilation with positive end-expiratory pressure (PEEP) or anemia. Early recognition and consideration of defect closure is essential when hypoxemia is refractory to conventional ventilatory maneuvers.
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Yang et al. (2026) conducted a case report in Severe mitral regurgitation (n=1). Percutaneous closure of iatrogenic atrial septal defect was evaluated on Resolution of hypoxemia. Percutaneous closure of an iatrogenic atrial septal defect rapidly resolved refractory hypoxemia caused by a right-to-left shunt following transcatheter edge-to-edge repair.
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