Key result
Tricuspid TEER reverses right-to-left shunting and restores oxygenation following complicated mitral TEER.
Why the study?
Iatrogenic atrial septal defects after transseptal interventions are usually insignificant but can cause clinically relevant right-to-left shunting and hypoxemia under specific hemodynamic conditions.
Does tricuspid TEER reverse right-to-left shunting and improve hypoxemia in patients with iatrogenic atrial septal defects after mitral TEER?
Case Report (n=1)
Does tricuspid TEER reverse right-to-left shunting and improve hypoxemia in patients with iatrogenic atrial septal defects after mitral TEER?
Treating concomitant tricuspid regurgitation with TEER can restore interatrial pressure balance and reverse iatrogenic right-to-left shunting following mitral TEER, potentially avoiding the need for atrial septal defect closure.
Tricuspid TEER may reverse post-mitral TEER hypoxemia from iatrogenic ASD; hypothesis-generating for shunt management in combined procedures.
BACKGROUND: Iatrogenic atrial septal defects are common after transseptal interventions and are usually clinically insignificant; however, under specific hemodynamic conditions, they may result in clinically relevant right-to-left shunting and hypoxemia. CASE SUMMARY: A 67-year-old woman with severe mitral and torrential tricuspid regurgitation underwent a combined transcatheter edge-to-edge repair (TEER) strategy. Shortly after successful mitral TEER, the patient developed acute hypoxemia (oxygen saturation decreased from 96% to 82%) during preparation for tricuspid intervention. Transesophageal echocardiography revealed a 0.7-cm iatrogenic atrial septal defect with predominant right-to-left shunting. Instead of defect closure, tricuspid TEER was performed, resulting in rapid improvement in oxygen saturation (to 95%) and reversal of shunt direction. DISCUSSION: Right-to-left shunting after mitral TEER may be driven by right-sided pressure overload and altered flow dynamics rather than the septal defect itself. CONCLUSIONS: Treating tricuspid regurgitation can restore interatrial pressure balance, reverse shunt direction, and potentially obviate the need for atrial septal defect closure.
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Onder et al. (2026) conducted a case report in Severe mitral and torrential tricuspid regurgitation (n=1). Tricuspid TEER was evaluated on Oxygen saturation and shunt direction. Tricuspid TEER restored interatrial pressure balance and reversed right-to-left shunting after mitral TEER, improving oxygen saturation from 82% to 95% without defect closure.
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