Transcatheter Edge-to-Edge Repair After Patent Foramen Ovale and Atrial Septal Defect Closure.

BACKGROUND

Transseptal puncture is essential for transcatheter edge-to-edge repair (TEER) but is challenging in patients with previously implanted septal closure devices.

CASE SUMMARY: A 79-year-old woman with prior transcatheter closure of both a patent foramen ovale and an atrial septal defect developed severe degenerative mitral regurgitation (MR). Transseptal access was considered difficult due to the 2 closure devices. However, chronic MR caused enlargement of the left atrium and interatrial septum, creating a narrow but feasible puncture zone. Using the VersaCross system, transseptal puncture was achieved, allowing TEER completion.

DISCUSSION: Left atrial and septal enlargement from MR can create puncturable spaces despite prior septal closure devices. The VersaCross system enables controlled septal crossing, expanding the feasibility of TEER in anatomically complex patients.

TAKE-HOME MESSAGE: Chronic atrial remodeling secondary to severe MR may facilitate transseptal access after septal closure, and the VersaCross system can support safe puncture in challenging TEER cases.