Acquired right-to-left shunt through an atrial septal perforation with cyanosis after percutaneous transvenous mitral commissurotomy

Nakao, Masakazu; Ch’ng, Jack Kian; Sin, Yoong Kong; Chua, Yeow Leng; Lee, Chung Yin

doi:10.1016/j.jtcvs.2007.10.038

Cited by 6 publications

(4 citation statements)

References 3 publications

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“…There are multiple case reports of the deleterious effects of iASD (hypoxemia, heart failure, and systemic embolization). [8][9][10][11][12][13][14][15] There is only one single-center prospective study that suggested a possible negative impact of persistent iASD on right ventricular function, dyspnea, and mortality after TMVR Other studies have evaluated the effect of iASD on clinical outcomes, but were underpowered due to the very low incidence of adverse events (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Atrial Septal Defect

Alkhouli

Sarraf

Holmes

2016

Circ: Cardiovascular Interventions

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Atrial Septal Defect

Alkhouli

Sarraf

Holmes

2016

Circ: Cardiovascular Interventions

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“…Paradoxical embolism resulting in a transient ischemic attack (TIA) in a patient with history of iASD following TS puncture for percutaneous balloon mitral valvuloplasty (PBMV) has been described 5 . Acquired cyanotic heart disease has been reported in a patient who developed right‐to‐left shunting (RLS) after PBMV 6 . L’Epine et al described an episode of acute right heart failure in a 61‐year‐old female with residual left‐to‐right shunting after PBMV 7 .…”

Section: Introductionmentioning

confidence: 99%

“…5 Acquired cyanotic heart disease has been reported in a patient who developed right-to-left shunting (RLS) after PBMV. 6 L'Epine et al described an episode of acute right heart failure in a 61-yearold female with residual left-to-right shunting after PBMV. 7 Here, we review the existing case series of iASD, discuss reported incidence and clinical significance of residual iASD, and present emerging techniques utilizing TS access to the left atrium where iASD may result.…”

Section: Introductionmentioning

confidence: 99%

Transseptal Left Heart Catheterization and the Incidence of Persistent Iatrogenic Atrial Septal Defects

McGinty

Smith

Rogers

2011

J Interven Cardiology

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iASDs are frequent following TS access and a majority resolve over time. Available evidence suggests iASDs are well tolerated but late term follow-up is limited. With the increased utilization of TS transcatheter procedures, the frequency and size of iASDs may rise. Understanding the rare but serious clinical implications of iASD and the need for systematic surveillance in the future is warranted.

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“…Th ere are other publications on the subject of iatrogenic ASD that shows how important is this subject [17][18][19][20][21][22][23][24][25][26][27][28].…”

Section: International Journal Of Cardiovascular Diseases and Diagnosismentioning

confidence: 99%

Long-Term Follow-Up of Atrial Septal Defect Closure after Percutaneous Balloon Mitral Valvuloplasty by Transesphageal Echocardiography?

Rafla¹,

Bishay²

2019

Int J Cardiovasc Dis Diagn

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Percutaneous Balloon Mitral Valvuloplasty (PBMV) involves atrial septostomy during the procedure. One of the consequences of transseptal puncture is the creation of an Atrial Septal Defect (ASD). Transesophageal Echocardiography (TEE) can detect Left to Right (L-R) shunts too small to be detected by other methods. The aim of this study was to evaluate the 3 years follow-up of ASD closure after PBMV by TEE. 200 consecutive patients with rheumatic Mitral Stenosis (MS) who underwent successful PBMV by using the Inoue balloon catheter were studied prospectively. ASD with small L-R atrial shunting occurred in all the patients (100%) immediately after PBMV. Total study 200 patients. All the ASDs were small in size (≤ 5 mm). The puncture site (ASD site) occurred in the fossa ovalis (Fo.Ov) in 120 patients (60%), while it occurred outside the Fo.Ov (either in the superior limbus or in the inferior limbus of the Interatrial Septum (IAS)) in the other 80 patients (40%). 180 patients presented at 6 month follow-up. ASD was closed in 117 patients (65%), while it was persisted in 63 patients (35%). 95 patients presented at 3 years follow-up. ASD was closed in 76 patients (80%) (Group I), while it was persisted in 19 patients (20%) (Group II). All the 74 patients who had ASD immediately after PBMV in the Fo.Ov, presented with ASD closure at 3 years follow-up. Only 2 patients who had ASD immediately after PBMV outside the Fo.Ov, presented with ASD closure at 3 years follow-up. All the 19 patients who presented at 3 years follow-up with ASD persistence had ASD immediately after PBMV outside the Fo.Ov (14 in the superior limbus and 5 in the inferior limbus). No patient presented at 3 years follow-up with ASD persistence, had ASD immediately after PBMV in the Fo.Ov Large LAD, high total Echocardiographic (echo) score of the Mitral Valve (MV), thick Fo.Ov, thick superior limbus, thick inferior limbus and ASD site immediately after PBMV outside the Fo.Ov were significant predictors of ASD persistence at 3 years follow-up. In conclusion, ASD with L-R atrial shunting occurs in all the patients after PBMV by using the Inoue balloon catheter. ASD after PBMV persists in 20% of the patients at 3 years follow-up. Predictors of ASD persistence at 3 years follow-up are: large LAD, high total echo score of the MV, thick Fo.Ov, thick superior limbus, thick inferior limbus and ASD site immediately after PBMV outside the Fo.Ov. ASD closes at 3 years follow-up in all the patients who had ASD in the Fo.Ov immediately after PBMV. All the patients with ASD persistence at 3 years follow-up had ASD outside the Fo.Ov after PBMV. It is recommended that operators doing transseptal puncture during PBMV by using the Inoue balloon catheter should aim to do it in the Fo.Ov.

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Acquired right-to-left shunt through an atrial septal perforation with cyanosis after percutaneous transvenous mitral commissurotomy

Cited by 6 publications

References 3 publications

Iatrogenic Atrial Septal Defect

Iatrogenic Atrial Septal Defect

Transseptal Left Heart Catheterization and the Incidence of Persistent Iatrogenic Atrial Septal Defects

Long-Term Follow-Up of Atrial Septal Defect Closure after Percutaneous Balloon Mitral Valvuloplasty by Transesphageal Echocardiography?

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