Case Report (n=1)
Careful evaluation of the interatrial septum with transoesophageal echocardiography is crucial before transseptal puncture for percutaneous mitral valve therapy to identify potential thrombi in structures like a left-atrial septal pouch.
Supports pre-procedural TEE to detect rare septal thrombi; leaves open need for systematic screening studies before transseptal access.
An 82-year-old female patient with severe mitral regurgitation was referred for evaluation of percutaneous mitral valve repair. Transoesophageal echocardiography revealed a left-atrial septal pouch (LASP) with an echogenic structure. Following the heart-team decision, interventional therapy was therefore discarded. During surgery, a thrombus in the LASP was found and carefully resected. Afterward, conventional valve replacement with a biological 31-mm SJM-EPIC prosthesis (Abbott Structural Heart Devices, Santa Clara, CA) was performed. In the fast-evolving field of interventional mitral valve therapy, a trans-septal approach is the common strategy. Therefore, careful evaluation of the interatrial septum-which may contain thrombi with transoesophageal echocardiography before intervention-is of crucial importance.
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Gerçek et al. (2021) conducted a case report in Severe mitral regurgitation with left-atrial septal pouch thrombus (n=1). Surgical resection of thrombus and conventional valve replacement was evaluated.
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