Interatrial shunts: technical approaches to percutaneous closure.

Introduction: Interatrial shunt closure is considered the first-line therapy for congenital simple communications such as patent forame ovale (PFO), atrial septal defect (ASD), and post surgical interatrial communications.Areas covered: Anatomical, functional, and technical details useful for planning a transcatheter-based closure procedure are discussed as well as the available equipments and their use and the procedural routes and the specific closure techniques.Expert commentary: Anatomical and functional details, appreciated at both pre-procedural and intraprocedural steps, are of paramount importance for planning interatrial shunts transcatheter - based closure procedures. Rims of the defects, borders of the fossa ovalis, presence and relevance of atrial septal aneurysm, persistence of Eustachian valve or cor triatriatum dexter, and interatrial septum hypertrophy or lipomatosis are all factors to be investigated when planning the procedure and selecting the device. Routes for interventions should include femoral, and eventually the jugular and hepatic vein approaches. Intraprocedural transoesophageal echocardiography (TTE) or intracardiac echocardiography (ICE) should be used at least in most complex cases to have the exact definition of the anatomy of the defects. Future developments of device material and imaging tools are expected to improve safety and long-term efficacy even in the most complex cases.