In the modern era of structural heart interventions, the total number of transseptal procedures is growing exponentially, thus increasing the rate and need for management of iatrogenic atrial septal defects (iASDs). To date, there are no official guidelines on the assessment and management of iASDs, due to inconclusive evidence on whether patients benefit more from the percutaneous closure of iASD than from conservative management and vigorous follow‐up. Despite the abundance of observational studies on iASDs, there is still a lack of randomized studies. Evidence so far show that percutaneous closure is no superior over conservative treatment in patients with iASDs, however, it has been demonstrated that patients with spontaneous closure of iASDs experience less heart failure (HF) hospitalizations. On the other hand, researchers have investigated the beneficial nature of interatrial shunt therapy in patients with HFpEF and, more recently, with HFrEF, due to the presumed hemodynamic benefits. Herein, we provide an updated review of relevant literature, focusing on iASD persistence rates, predicting factors for their persistence, and clinical outcomes of iASD persistence, to summarize available evidence and discuss future directions in the field.

中文翻译：

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结构性心脏干预中的医源性房间隔缺损：打开潘多拉魔盒


在结构性心脏介入的现代时代，房间隔手术的总数呈指数级增长，从而增加了医源性房间隔缺损（iASD）的发生率和治疗需求。迄今为止，还没有关于 iASD 评估和管理的官方指南，因为关于患者从经皮 iASD 封堵术中获益是否比保守治疗和积极随访中获益更多的证据尚无定论。尽管有大量关于 iASD 的观察性研究，但仍然缺乏随机研究。迄今为止的证据表明，对于 iASD 患者，经皮封堵术并不优于保守治疗，但是，已经证明，iASD 自发封堵患者的心力衰竭 (HF) 住院率较低。另一方面，由于假定的血流动力学益处，研究人员研究了心房分流疗法对 HFpEF 患者以及最近的 HFrEF 患者的有益性质。在此，我们对相关文献进行了更新回顾，重点关注 iASD 持续率、其持续的预测因素以及 iASD 持续的临床结果，以总结现有证据并讨论该领域的未来方向。