経皮的僧帽弁接合不全修復術に伴う医原性心房中隔欠損により高度な右左シャントを生じた1症例

An Iatrogenic Atrial Septal Defect（iASD）Following Transcatheter Edge-to-Edge Repair（TEER）Causing Severe Right-Left Shunt

要旨

　経皮的僧帽弁接合不全修復術（transcatheter edge-to-edge repair：TEER）中に高度な右左シャントを伴う医原性心房中隔欠損（iatrogenic atrial septal defect：iASD）を生じ，迅速な静脈-動脈体外式膜型人工肺（veno-arterial extracorporeal membrane oxygenation：V-A ECMO）の導入と早期の経皮的心房中隔欠損孔閉鎖術を要した症例を経験した。術前に右房圧や肺動脈圧が高い場合は，iASDから重篤な右左シャントを生じて，急激な低酸素や循環不全に陥ることがあり，術前から対応を検討しておくことが必要である。

　We provide the details of a case in which an iatrogenic atrial septal defect（iASD）with a severe right-to-left shunt occurred during transcatheter edge-to-edge repair（TEER）, necessitating the urgent initiation of veno-arterial extracorporeal membrane oxygenation（VA-ECMO）and early transcatheter atrial septal defect closure. The patient was a 79-year-old man for whom TEER was performed to treat heart failure due to severe mitral regurgitation. Severe hypoxemia and eirculatory collapse occurred as a consequence of an iASD created during TEER；however, the patient had a favorable outcome following prompt initiation of VA-ECMO and surgical closure of the iASD. This case highlights the possibility that when a patient’s right atrial pressure or pulmonary artery pressure is elevated pre-procedure, an iASD can lead to severe right-to-left shunting, resulting in acute hypoxemia and circulatory collapse. It is therefore crucial to anticipate and plan for such potential complications prior to the procedure.