This retrospective study compared patients requiring emergency closure of an iatrogenic atrial septal defect after successful M-TEER with the remaining cohort. Among 444 consecutive patients, six (1.3%) required emergency closure for right-to-left shunting and acute deoxygenation. All six had severe tricuspid regurgitation, right ventricular dilatation and impaired right ventricular function; right atrial pressure exceeded left atrial pressure after M-TEER in five. Compared with controls, affected patients had lower tricuspid annular plane systolic excursion, fractional area change and right ventricular free wall strain magnitude. One patient developed cardiogenic shock.
These findings suggest that right ventricular dysfunction and adverse atrial pressure relationships may help identify patients vulnerable to acute right-to-left shunting after M-TEER. They do not establish a validated prediction strategy.
Study limitation: The retrospective design and only six emergency closure events limit the reliability and generalizability of risk-factor associations.
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