Cardiovascular Department, University of Salerno, Via San Leonardo 1, 84132, Salerno, Italy.
Hessen Pediatric Heart Center Giessen & Frankfurt, Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.
Heart Fail Rev. 2018 Nov;23(6):841-847. doi: 10.1007/s10741-018-9741-9.
Elevated left atrial (LA) filling pressures are associated with poor prognosis in patients with heart failure (HF). Recent evidences have shown that, in this setting, the presence of restrictive small atrial defect may protect from an extreme increase in LA pressure and prevent consecutive pulmonary congestion and acute decompensation, without the expense of an unfavourable significant left-to-right shunt. Therefore, decompression of LA by creating a unidirectional but restrictive left-to-right interatrial shunt has been emerging as a new therapeutic strategy in patients suffering from both HF with preserved and reduced ejection fraction. Two dedicated devices (V-Wave and interatrial septal device system-IASD) are currently available to create a restrictive interatrial communication. Several clinical studies have demonstrated the safety of this approach, with encouraging results regarding the improvements in haemodynamic parameters, functional status and quality of life in treated patients. We aim to summarize the present knowledge concerning this novel therapeutic approach for HF, describe the currently available devices and depict their potential future clinical indications.
左心房（LA）充盈压升高与心力衰竭（HF）患者的预后不良相关。最近的证据表明，在这种情况下，存在限制型小房缺可能会防止 LA 压的极度升高，并防止随后的肺充血和急性失代偿，而不会导致不利的显著左向右分流。因此，通过创建单向但限制型的左向右房间分流来减轻 LA 的压力，已成为患有射血分数保留和降低的 HF 患者的一种新的治疗策略。目前有两种专用设备（V-Wave 和房间隔装置系统-IASD）可用于创建限制型房间隔交通。多项临床研究表明了这种方法的安全性，治疗患者的血流动力学参数、功能状态和生活质量得到了令人鼓舞的改善。我们旨在总结关于这种治疗 HF 的新方法的现有知识，描述目前可用的设备，并描述它们潜在的未来临床适应证。
