Published in:
20-10-2021 | Transthoracic Echocardiography | Images in Cardiovascular Intervention
Percutaneous closure of an iatrogenic atrial septal defect with bidirectional shunt for hemodynamic collapse following percutaneous transvenous mitral commissurotomy
Published in: Cardiovascular Intervention and Therapeutics | Issue 3/2022
Login to get accessExcerpt
A 75-year-old woman with severe, symptomatic mitral stenosis underwent percutaneous transvenous mitral commissurotomy (PTMC) using a 24-mm INOUE-BALLOON via the right common femoral vein (Fig. 1A). Her mitral valve area (MVA) and mean pressure gradient (MPG) measured by transthoracic echocardiography (TTE) improved MVA from 0.87 to 1.51 cm2 and MPG from 16 to 5 mmHg, respectively. Her pulmonary wedge pressure decreased from 15 to 13 mmHg, whereas the right atrial pressure increased from 10 to 15 mmHg owing to left-to-right shunt through iatrogenic atrial septal defect (iASD). Her clinical course was good following the procedure. However, on postoperative day 5, she complained of severe weakness and mild confusion. She suddenly experienced hemodynamic collapse with a blood pressure of 72/42 mmHg, a heart rate of 60 beats/min, a percutaneous oxygen saturation (SpO2) of 90% on room air, and metabolic acidosis.
Fig. 1
An apical four-chamber TTE view just after PTMC procedure showed a left-to-right shunt through the iASD (A). A subxiphoid four-chamber TTE view at hemodynamic collapse showing a right-to-left shunt in systole through the iASD (B). A bidirectional shunt through the iASD on color Doppler M-mode TEE (C). A 3D TEE image showed that the iASD was located at the center of the fossa ovalis and was split shaped (D). The iASD closed with an 11-mm Amplatzer septal occluder (E, F). ASD atrial septal defect, PTMC percutaneous transvenous mitral commissurotomy, TEE transesophageal echocardiography, TTE transthoracic echocardiography
× ![]()
…