Hemodynamic patterns of residual interatrial communication after transcatheter MitraClip repair

Aims We sought to assess the hemodynamic sequel and the therapy adopted in patients treated with MitraClip system, who experienced a persistent interatrial communication (IAC) after the procedure. Methods From January 2012 to March 2013, 28 consecutive patients (mean age 74 ± 8 years) underwent transcatheter MitraClip repair, as part of an ongoing prospective study to assess the IAC. Results Acute procedural success was 100% and a 30-days survival of 97% was reported. Immediately after the procedure, a residual IAC was present in all patients with an average diameter of 0.51 ± 0.39 cm. At 30 days, IAC was detected in 81% of patients with a diameter of 0.45 ± 0.31 cm (P = 0.53). To date, three patients developed different hemodynamic impairment secondary to the residual IAC, requiring percutaneous closure of the defect. Conclusion Anatomic and hemodynamic criteria for early recognition of harmful residual IAC have to be identified, in order to select those patients who are benefited the most from atrial septal defect closure.