Key result
Mitral transcatheter edge-to-edge repair was complicated by a rare iatrogenic fistula between the right main pulmonary artery and left atrium, leading to persistent hypoxia and eventual death.
Case Report (n=1)
This case report describes the first known instance of an iatrogenic right pulmonary artery to left atrium fistula causing persistent hypoxia and right-to-left shunting following mitral transcatheter edge-to-edge repair, highlighting the importance of timely recognition and consideration of cerebral embolic protection.
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Clinicians should consider rare iatrogenic PA-LA fistula in post-TEER hypoxia; case report leaves open incidence and prevention.
BACKGROUND: Mitral regurgitation (MR) is a common disorder associated with increased risk of morbidity and mortality. Transcatheter edge-to-edge repair (TEER) is a minimally invasive option that is increasingly used in the management of this condition. Randomized controlled trials have concluded that TEER is safe and effective in reducing secondary MR. CASE SUMMARY: An 81-year-old woman underwent mitral TEER for severe secondary MR. She suffered from ongoing hypoxia postprocedure because of an iatrogenic fistula between the right main pulmonary artery and left atrium with right to left shunt. DISCUSSION: This case represents a unique and rare complication of mitral TEER. TAKE-HOME MESSAGES: Rare but life-threatening complications of mitral TEER should be recognized in a timely manner. Finally, clinicians should consider filter-based cerebral protection system during TEER; however, further studies on its utility are warranted.
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Almoosa et al. (2025) conducted a case report in Severe secondary mitral regurgitation (n=1). Mitral transcatheter edge-to-edge repair (TEER) was evaluated. Mitral transcatheter edge-to-edge repair was complicated by a rare iatrogenic fistula between the right main pulmonary artery and left atrium, leading to persistent hypoxia and eventual death.
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