Iatrogenic Atrial Septal Defect.

The number of left atrial transcatheter procedures performed via a transseptal (TS) approach has grown exponentially over the last 2 decades. Persistent iatrogenic atrial septal defects (iASD) after structural TS interventions are not uncommon especially when larger TS sheaths are used (25%–50% with 22 Fr sheaths). The optimal management strategy of postprocedural iASD is currently unknown. In the absence of societal recommendations with regards to iASD, the decision to close iASD and the timing of the closure pose a clinical dilemma to the interventionalist caring for these patients. We present 2 cases of iASD after TS transcatheter mitral valve repair/implantation and discuss the challenges in the management of such patients.