Simultaneous Repair of Iatrogenic Left Atrial and Aortic Perforations Using Ductus Arteriosus Occluders: A Case Report

Iatrogenic perforation of the left atrium and aorta during transseptal puncture (TSP) is a rare but potentially life-threatening complication. This report presents the case of an elderly male patient with a 20-year history of atrial fibrillation who experienced this complication during a scheduled left atrial appendage closure procedure. During the procedure, the sheath inadvertently penetrated the left atrial wall and mediastinal tissues, resulting in perforation of the descending aorta. To prevent hemorrhage and secondary injury, we successfully repaired the defects by simultaneously deploying two ductus arteriosus occluders through the original access tract. Immediate post-procedural and 1-month follow-up assessments confirmed stable device position with no residual shunt, pericardial effusion, or thromboembolic complications. This case represents the first documented instance of concurrent closure of both left atrial and descending aortic perforations using ductus arteriosus occluders. It highlights the critical importance of prompt intervention for complex cardiac complications and demonstrates the feasibility of dual-chamber repair using occluder devices.