Transcatheter Edge-to-Edge Mitral Valve Repair Through a Native Atrial Septal Defect: An Anatomy-Guided Strategy

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.

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.

Preprocedural multimodality imaging may help determine procedural feasibility. In patients with decompensated heart failure, staged ASD closure after M-TEER may be preferable.

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.