Objectives To investigate prevalence of iatrogenic atrial septal defects (iASDs) after mitral valve (MV) transcatheter edge-to-edge repair (TEER) with the MitraClip in the long-term follow-up. Background MV TEER requires transseptal puncture using a large 22 F sheath. Prevalence, impact and haemodynamic effects of these iASDs remain unknown in the long-term follow-up. Methods This prospective study enrolled patients who had undergone first-time TEER at our university hospital between January 2017 and June 2018 for a clinical long-term follow-up study. Prevalence of iASD was investigated 12 months post-TEER using transoesophageal echocardiography (TEE). Study protocol further consisted of transthoracic echocardiography (TTE) and exercise testing. Incidence of all-cause death was compared 12 months post-TEE follow-up. This study was approved by local ethics committee. Results 48 patients participated in clinical follow-up examinations. Median time between TEER and clinical follow-up examination (TEE, TTE, exercise testing) was 19.5 (IQR: 7.0) months after TEER. Persistent iASD was found in 41.7% of patients. TEER was found to be equally effective in reducing MR and clinical symptoms in both groups at baseline as well as follow-up. Procedural fluoroscopy and device times were significantly longer in the iASD group. MR reduction and functional status (New York Heart Association Class, 6 Minute Walking Test distance) were similar in both groups. Nevertheless, a significant decrease in systolic pulmonary artery pressure (sPAP) and significantly smaller atrial diameters were observed in patients with iASD at follow-up. Conclusion Prevalence of iASDs after TEER in long-term follow-up was about 41%. Although a significant reduction of sPAP and better left atrial reverse remodelling were accomplished in patients with iASD, clinical impact appears low. Manipulation at the atrial septum might play a key role in creating persisting iASD. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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长期随访中二尖瓣 (MV) 经导管边缘对边缘修复 (TEER) 后医源性房间隔缺损 (iASD) 的患病率

目的 调查在长期随访中使用 MitraClip 进行二尖瓣 (MV) 经导管边缘对边缘修复 (TEER) 后医源性房间隔缺损 (iASD) 的发生率。背景 MV TEER 需要使用大的 22 F 鞘进行经间隔穿刺。这些 iASD 的患病率、影响和血流动力学影响在长期随访中仍然未知。方法本前瞻性研究纳入2017年1月至2018年6月在我校医院首次接受TEER的患者进行临床长期随访研究。使用经食道超声心动图 (TEE) 在 TEER 后 12 个月调查 iASD 的患病率。研究方案还包括经胸超声心动图 (TTE) 和运动测试。比较了 TEE 随访后 12 个月的全因死亡发生率。本研究经当地伦理委员会批准。结果48例患者参加临床随访检查。TEER 与临床随访检查（TEE、TTE、运动测试）之间的中位时间为 TEER 后 19.5 (IQR: 7.0) 个月。41.7% 的患者存在持续性 iASD。发现 TEER 在基线和随访时均能有效减少两组的 MR 和临床症状。iASD 组的程序性透视和设备时间显着延长。两组的 MR 减少和功能状态（纽约心脏协会等级，6 分钟步行测试距离）相似。然而，在随访中观察到 iASD 患者的收缩期肺动脉压 (sPAP) 显着降低，心房直径显着变小。结论 TEER 后长期随访中 iASD 的患病率约为 41%。尽管 iASD 患者的 sPAP 显着降低和左心房逆向重构得到改善，但临床影响似乎很低。房间隔的操作可能在产生持续性 iASD 中起关键作用。所有与研究相关的数据都包含在文章中或作为补充信息上传。