Interatrial Shunt Devices

Heart failure with preserved ejection fraction (HFpEF) remains difficult to manage while contributing to high morbidity and mortality. It is a complex disease state with a pathophysiology based in a multitude of contributing factors. One common aspect of HFpEF is the presence of increased LV end diastolic pressure (LVEDP) resulting in elevated left atrial (LA) pressure. Increased LA pressure may also be the best guide in assessing if dyspnea is the result of elevated LA pressures leading to pulmonary congestion. In this chapter, we will discuss the evolving field of interatrial shunt devices (IASD) which target elevated LA pressures as a possible therapeutic option in patients with HFpEF. This chapter will discuss prevalence, morbidity and mortality of HFpEF, along with the pathophysiology of elevated left atrial pressures in HFpEF, and treatment options using interatrial shunt devices. Lastly, an example case of a patient undergoing an IASD placement with pre, intra and post procedural imaging guidance will be reviewed.