Abstract
Experimental studies have demonstrated hemodynamic, echocardiographic, and survival benefits with the creation of small interatrial shunts that selectively unload the left heart. In addition Patients with left‐sided valve disease and an atrial septal defect (ASD) have better outcomes than those with valve disease alone, which suggests benefit from left atrial (LA) decompression. Interatrial shunt creation is an emerging interventional treatment for patients with acute and chronic HF. Interatrial shunting is expected to benefit patients with abnormal LA filling pressures, at rest or upon exertion. HF management guided by pulmonary diastolic pressure (a surrogate for LA pressure) has been shown to reduce HF hospitalizations and improve short‐ and long‐term outcomes. Shunt devices are especially promising in patients with heart failure with preserved ejection fraction (HFpEF) as there is a lack of effective therapies. This chapter reviews the principal steps in for the creation of an interatrial shunt percutaneously and the primary interatrial shunt devices currently under investigation.