Key result
Parallel balloon septal occlusion resolves acute right-to-left shunting to permit safe M-TEER completion.
Why the study?
Right-to-left shunting across an iatrogenic atrial septal defect during mitral transcatheter edge-to-edge repair is rare but can cause significant hypoxemia in high-risk patients.
Case Report (n=1)
Parallel balloon septal occlusion is a novel and practical bailout technique to manage acute right-to-left iatrogenic atrial septal defect shunting during transcatheter edge-to-edge repair while preserving transseptal access.
Right-to-left IASD shunting should be considered in post-M-TEER hypoxemia; this Level 5 case leaves optimal detection and management open.
BACKGROUND: Mitral transcatheter edge-to-edge repair (M-TEER) requires large-bore transseptal puncture, creating an iatrogenic atrial septal defect (IASD). Right-to-left shunting across an IASD is rare but can cause significant hypoxemia in high-risk patients. CASE SUMMARY: A 78-year-old man with nonischemic cardiomyopathy and severe mitral and tricuspid regurgitation underwent M-TEER. Profound hypoxemia secondary to acute right-to-left shunt developed immediately after transseptal instrumentation with a large-bore sheath. A compliant sizing balloon was inflated across the septal defect in parallel with the transseptal sheath, restoring oxygenation and allowing safe deployment of the PASCAL (Edwards Lifesciences) valve, with septal closure performed at the end of the procedure. DISCUSSION: This case illustrates a distinctive predeployment presentation of right-to-left IASD shunting and a novel bailout technique that preserves transseptal access without requiring additional venous puncture. TAKE-HOME MESSAGES: Right-to-left IASD shunting should be anticipated in patients with high-risk hemodynamic profiles before transseptal puncture. Parallel balloon septal occlusion represents a practical bridging strategy enabling safe M-TEER completion.
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Radhakrishna et al. (2026) conducted a case report in Acute right-to-left shunt during mitral transcatheter edge-to-edge repair (n=1). Parallel balloon septal occlusion was evaluated on Restoration of oxygenation and safe deployment of the M-TEER valve. Parallel balloon septal occlusion successfully restored oxygenation and enabled safe M-TEER completion in a 78-year-old man with acute right-to-left shunting.
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