Key result
Native secundum ASD enables successful M-TEER access without requiring additional septal puncture.
Why the study?
An anatomy-guided strategy using a native secundum atrial septal defect as the sole transseptal access route for mitral valve repair has not been described.
A native secundum atrial septal defect can be safely utilized as the sole transseptal access route for M-TEER when guided by preprocedural multimodality imaging.
May support native ASD access to avoid extra puncture in select TEER cases; hypothesis-generating and requires prospective validation.
OBJECTIVE: To describe an anatomy-guided transcatheter edge-to-edge mitral valve repair (M-TEER) strategy using a native secundum atrial septal defect (ASD) as the sole transseptal access route. KEY STEPS: Preprocedural computed tomography and 3-dimensional transesophageal echocardiography to assess the access route, ASD anatomy, and anticipated guide catheter alignment. Guidewire and steerable guide catheter advancement through the native ASD under real-time 3-dimensional transesophageal echocardiography guidance. Sequential M-TEER device deployment with continuous hemodynamic and oximetric monitoring. Confirmation of mitral regurgitation reduction and planned staged ASD closure. POTENTIAL PITFALLS: Preprocedural multimodality imaging may help determine procedural feasibility. In patients with decompensated heart failure, staged ASD closure after M-TEER may be preferable. TAKE-HOME MESSAGES: Preprocedural multimodality imaging may identify patients in whom a native secundum ASD can serve as the sole transseptal access route for M-TEER, avoiding additional septal puncture. In patients with decompensated heart failure, staged ASD closure after successful M-TEER may be preferable.
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Kanda et al. (2026) studied Mitral regurgitation with native secundum atrial septal defect. Transcatheter edge-to-edge mitral valve repair (M-TEER) via native ASD was evaluated. A native secundum atrial septal defect can serve as the sole transseptal access route for transcatheter edge-to-edge mitral valve repair, avoiding the need for additional septal puncture.
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