Interatrial Shunt Hemodynamics and Clinical Outcomes: Scoping Review with ☸️SAIMSARA

Name: SAIMSARA Evidence Object vascular::INTERATRIAL_SHUNT_PM
Creator: SAIMSARA
License: https://saimsara.com/license/

SAIMSARA

doi:10.62487/saimsara46ef58f3

SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Interatrial Shunt Hemodynamics and Clinical Outcomes: Scoping Review with ☸️SAIMSARA

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

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DOI: 10.62487/saimsara46ef58f3

Editorial note

• Last update: 2026-06-16 13:51:42

What is this paper about

Interatrial shunts can either unload the failing left atrium or drive stroke, hypoxemia, and right-heart deterioration—depending on flow direction and the underlying cardiac phenotype. Built from 218 references, 502 original studies, and 77,138 observations, this review reveals which patients may benefit from shunt creation, who may be harmed, and when closure becomes clinically decisive.

Human-verified editorial review Verified by World ID proof-of-human. This editorial layer was submitted from a SAIMSARA account verified as a unique human.

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Abstract: To map the breadth and depth of evidence on the interatrial shunt, synthesizing findings from clinical trials, observational studies, and experimental models to characterize its hemodynamic effects, diagnostic approaches, clinical sequelae, and the outcomes of therapeutic creation or closure. The review uses 218 references and builds its evidence map from 502 original studies with 77138 total participants/sample observations (topic-deduplicated ΣN). This scoping review highlights that the clinical significance of an interatrial shunt is governed by flow direction and hemodynamic substrate, producing a therapeutic dichotomy between beneficial left atrial unloading and pathological right-to-left flow. The most consistent signal suggests that transcatheter shunt creation may benefit heart failure with reduced ejection fraction yet harm preserved ejection fraction phenotypes, as seen in the RELIEVE-HF trial. Conversely, right-to-left shunting was repeatedly associated with cryptogenic stroke, platypnea-orthodeoxia, and refractory hypoxemia, where percutaneous closure was associated with near-universal procedural success and sustained oxygenation gains. These findings support a phenotype-driven approach in which shunt manipulation is tailored to the underlying physiology rather than applied uniformly. Future LVEF-stratified randomized trials with longer follow-up are needed to confirm the differential treatment effect and clarify which patients derive durable net benefit.
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Keywords: interatrial shunt; heart failure; patent foramen ovale; cryptogenic stroke; left atrial pressure; right-to-left shunt; transcatheter closure; pulmonary hypertension; cardiac remodeling; shunt hemodynamics

Review Stats

Final search date and database lock: 2026-06-03 22:18:17 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 874
Downloaded Abstracts/Papers: 874
Included original and non-original Abstracts/Papers (all): 611
Included original Abstracts/Papers (Vote counting by direction of effect): 502
Reference Index (links used in paper): 218
Total participants/sample observations (topic deduplicated ΣN): 77138

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Reference Index (218)

[1] Interatrial Shunt Devices. — https://doi.org/10.1016/j.hfc.2023.05.003
[2] Interatrial Shunt Treatment for Heart Failure: The Randomized RELIEVE-HF Trial. — https://doi.org/10.1161/circulationaha.124.070870
[3] Patent foramen ovale. — https://doi.org/10.1136/practneurol-2019-002450
[4] Interatrial shunt devices for heart failure. — https://doi.org/10.1038/s41569-023-00923-w
[5] Identification of High-Risk Patent Foramen Ovale Associated With Cryptogenic Stroke: Development of a Scoring System. — https://doi.org/10.1016/j.echo.2019.03.021
[6] Interatrial shunt devices for the treatment of heart failure. — https://doi.org/10.1016/j.tcm.2020.09.004
[7] Mechanistic Basis for Differential Effects of Interatrial Shunt Treatment in HFrEF vs HFpEF: The RELIEVE-HF Trial. — https://doi.org/10.1016/j.jcmg.2025.08.005
[8] In Vitro Pressure Measurements Across an Interatrial Shunt for HFpEF Treatment. — https://doi.org/10.1007/s13239-021-00607-x

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