Iatrogenic atrial septal defect after implantation of MitraClip device: treatment to whom and when?

Successful MitraClip implantation, although deteriorates mitral regurgitation, leads inevitably to the presence of an iatrogenic atrial septal defect, because of the large guiding catheter used. Half of them will close immediately after implantation of the device, in the next 6 months, but the remaining may persist. Although the primary effect of their existence, is associated with a relatively small left to right shunt, relieving left atrium from chronic elevated pressure, there is not enough data in the literature concerning progression in time, leading to the question, whether they should be closed or not. This is a case report of a patient with severe ischemic mitral regurgitation, treated by implantation of two MitraClip devices, with concomitant iatrogenic atrial septal defect and left to right shunt.