Left-to-right interatrial shunt percutaneously implanted devices: a new avenue in the treatment of heart failure

Abstract

Heart failure (HF) is highly prevalent with major impact on quality of life and survival, but still, has important therapeutic limitations. Elevated left atrial filling pressure has been associated to poor prognosis. In addition, previous experiences suggest that the remaining small atrial septal defects (ASD) may act in certain situations as 'outlet valves' preventing acute failure as happens during closure of large ASD, in other congenital cardiopathies and in patients under left ventricular assist devices. Shunts created by balloon-dilation at the interatrial septum have limited duration. However, recent experiences with two specific new systems (interatrial septal device system and V-Wave) have reported symptomatic improvement at mid-term. This intriguing hypothesis represents a new avenue in the treatment of HF if the impact is confirmed at long-term. Keywords: heart failure • IASD • interatrial shunt devices • left atrial pressure • V-Wave device •• This study was key to set the hypothesis that mechanisms helping to control left atrial pressure have a great prognostic impact leading to a whole new catalog of emerging therapies for heart failure. 44 Ritzema J, Melton IC, Richards AM et al. Direct left atrial pressure monitoring in ambulatory heart failure patients: initial experience with a new permanent implantable device. Circulation 116, 2952-2959 (2007).