{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:50:18Z","timestamp":1792183818430,"version":"4.4.0"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Right-to-left (R-L) shunting through an iatrogenic atrial septal defect (iASD) after mitral transcatheter edge-to-edge repair (M-TEER) is a rare but potentially life-threatening complication. We aimed to identify factors associated with clinically relevant R-L shunting requiring emergency iASD closure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We retrospectively analysed 444 consecutive patients undergoing successful M-TEER between 2017 and 2026. Clinical, echocardiographic, and invasive haemodynamic parameters were compared between patients requiring emergency iASD closure and the remaining cohort. Six patients (1.3%) required emergency iASD closure due to R-L shunting and acute deoxygenation. All presented with severe tricuspid regurgitation, RV dilatation, and impaired RV function. Following M-TEER, right atrial pressure exceeded left atrial pressure in five patients. Compared with controls, affected patients demonstrated reduced tricuspid annular plane systolic excursion (15 \u00b1 2 vs. 19 \u00b1 4 mm), fractional area change (FAC) (27 \u00b1 5% vs. 43 \u00b1 6%), and RV free wall strain (\u221213 \u00b1 2% vs. \u221222 \u00b1 5%). Echocardiography underestimated invasively measured systolic pulmonary artery pressure (25.8 vs. 40.3 mmHg; P = 0.035). Oxygen saturation decreased by 3-8%, with one patient developing cardiogenic shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Severe tricuspid regurgitation, RV dysfunction, and elevated right atrial pressure may identify patients at risk for clinically relevant R-L shunting after M-TEER. Comprehensive RV assessment, including FAC and strain, combined with invasive hemodynamic evaluation, may improve risk stratification and facilitate timely iASD closure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjimp\/qyag171","type":"journal-article","created":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T11:25:56Z","timestamp":1791113156000},"source":"Crossref","is-referenced-by-count":0,"title":["Acute deoxygenation during M-TEER: a note of caution"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7869-8363","authenticated-orcid":false,"given":"Michael","family":"Wester","sequence":"first","affiliation":[{"name":"University Heart Centre Regensburg , Franz-Josef-Strau\u00df-Allee 11, Regensburg 93053 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9413-885X","authenticated-orcid":false,"given":"Michael","family":"Paulus","sequence":"additional","affiliation":[{"name":"University Heart Centre Regensburg , Franz-Josef-Strau\u00df-Allee 11, Regensburg 93053 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Luchner","sequence":"additional","affiliation":[{"name":"Krankenhaus Barmherzige Br\u00fcder Regensburg , Regensburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9560-4015","authenticated-orcid":false,"given":"Christian","family":"Schach","sequence":"additional","affiliation":[{"name":"University Heart Centre Regensburg , Franz-Josef-Strau\u00df-Allee 11, Regensburg 93053 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9889-1264","authenticated-orcid":false,"given":"Bernhard","family":"Uns\u00f6ld","sequence":"additional","affiliation":[{"name":"University Heart Centre Regensburg , Franz-Josef-Strau\u00df-Allee 11, Regensburg 93053 ,","place":["Germany"]},{"name":"Medical Clinic I, Cardiology and Angiology, Justus-Liebig-University , Giessen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9915-4429","authenticated-orcid":false,"given":"Lars S","family":"Maier","sequence":"additional","affiliation":[{"name":"University Heart Centre Regensburg , Franz-Josef-Strau\u00df-Allee 11, Regensburg 93053 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4157-4911","authenticated-orcid":false,"given":"Can Martin","family":"Sag","sequence":"additional","affiliation":[{"name":"University Heart Centre Regensburg , Franz-Josef-Strau\u00df-Allee 11, Regensburg 93053 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Meindl","sequence":"additional","affiliation":[{"name":"University Heart Centre Regensburg , Franz-Josef-Strau\u00df-Allee 11, Regensburg 93053 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Debl","sequence":"additional","affiliation":[{"name":"University Heart Centre Regensburg , Franz-Josef-Strau\u00df-Allee 11, Regensburg 93053 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"2026101616273657500_qyag171-B1","doi-asserted-by":"crossref","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"2025 ESC\/EACTS guidelines for the management of 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defect after MitraClip procedure","volume":"13","author":"Morikawa","year":"2020","journal-title":"JACC Cardiovasc Interv"},{"key":"2026101616273657500_qyag171-B5","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1253\/circj.CJ-22-0048","article-title":"Iatrogenic atrial septal defect requiring transcatheter closure following transcatheter mitral valve repair","volume":"86","author":"Takaya","year":"2022","journal-title":"Circ J"},{"key":"2026101616273657500_qyag171-B6","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.echo.2025.01.006","article-title":"Guidelines for the echocardiographic assessment of the right heart in adults and special considerations in pulmonary hypertension: recommendations from the American Society of Echocardiography","volume":"38","author":"Mukherjee","year":"2025","journal-title":"J Am Soc 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