Background:
Transient ST-segment elevation or coronary artery spasm during transseptal catheterization has been previously described. Most cases were either reversible or asymptomatic.
Case summary:
We present a case of severe multiple coronary artery spasms with advanced atrioventricular block and ventricular fibrillation during compression of the fossa ovalis by a sheath catheter, before the performance of the transseptal puncture procedure for mitral transcatheter edge-to-edge-repair.
Discussion:
The mechanical effects of forward tension from transseptal puncture on the interatrial vagal network could be the most possible explanation for the occurrence of this phenomenon.