Delayed onset of aortic regurgitation after transcatheter closure of atrial septal defect: variable impact of the device on the aortic valve.

Although aortic valve regurgitation develops after device closure of the atrial septal defect, its mechanism remains unclear. We observed a paediatric patient who developed significant aortic regurgitation one year after the procedure. Although there was no contact between the aorta and the device immediately after deployment, they gradually came into close proximity. Multiple factors appeared to have contributed to this phenomenon, including a relatively large diameter of both the device and the aortic sinus compared to body size, and a rapid increase in the left atrial volume. Coupled with left atrial enlargement, the shrinkage of right atrial volume might also have affected the exacerbation of aortic regurgitation due to the geometrical change of the interatrial septum and the traction of the non-coronary aortic sinus in a few years after deployment. Importantly, the distance between the device and the aorta widened again, resulting in improvement of regurgitation. Aortic valve regurgitation after device placement may show a tendency to improve; therefore, careful judgement is required when considering the indication for aortic intervention.