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Updated: Apr 25, 2026

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Published on: February 8, 2022
Hyperacute Iatrogenic Atrial Septal Defect Expansion Driven by Tricuspid Regurgitation Jet Impingement
Yasuyo Takeuchi1, Mizuhiko Ishigaki2, Sung-Hae Kim2
1Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan.
Background:
Iatrogenic atrial septal defects (iASDs) after mitral transcatheter edge-to-edge repair (M-TEER) are generally benign. However, advanced atrial remodeling can trigger catastrophic mechanical failure via rapid morphologic expansion.
Case Summary:
An 84-year-old woman with atrial fibrillation and diastolic dysfunction underwent M-TEER. Despite a stable intraprocedural iASD, she developed cardiogenic shock within 3 hours. Three-dimensional transesophageal echocardiography documented hyperacute doubling of the defect area. The mechanism was direct tricuspid regurgitation (TR)-jet impingement on the thinned septum, reflecting severely impaired left atrial compliance. Emergency iASD closure using "stationary deployment" prevented further traumatic tearing, resulting in immediate hemodynamic stabilization.
Discussion:
This case identifies TR-jet impingement as a predictor of acute iASD expansion. Transesophageal echocardiography is essential for monitoring this mechanical vicious cycle.
Take-Home Messages:
Impaired atrial compliance and TR-jet impingement can cause rapid iASD enlargement after M-TEER. Prompt recognition and closure are vital for managing this life-threatening complication.
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