The Hidden Burden of Iatrogenic Atrial Shunting in Severe Tricuspid Regurgitation: A Case Report.
Clara Lopiano, Beatrice Pezzuto, Manuela Muratori et al.
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Case in brief
An 82-year-old woman with severe tricuspid regurgitation developed worsening hypoxemia due to a persistent iatrogenic atrial septal defect following atrial fibrillation ablation. After a heterotopic caval valve implantation aimed at alleviating systemic congestion, her hypoxemia intensified due to increased right-to-left shunting. Successful percutaneous closure of the atrial septal defect led to immediate normalization of oxygenation and significant symptom improvement.
Diagnostic / clinical pearl
In patients with severe tricuspid regurgitation, even small iatrogenic atrial septal defects can lead to significant hemodynamic consequences, particularly after procedures like caval valve implantation.
Why it matters
This case highlights the need for careful hemodynamic assessment in patients with pre-existing interatrial defects, as interventions may exacerbate right-to-left shunting and worsen clinical outcomes.