Key result
Hemodynamic evaluation of 6 patients with worsening heart failure after atrial shunt implantation suggested that intentional shunt closure may have been detrimental in 5 cases and beneficial in 1.
Why the study?
Intentional closure of an implanted atrial shunt had not been previously reported in patients with worsening heart failure and shunt flow reversal.
Case Report (n=6)
Thorough hemodynamic evaluation is critical before considering closure of an implanted atrial shunt in patients with worsening heart failure and flow reversal, as closure may often be detrimental.
Caution advised against routine atrial shunt closure in worsening HF; leaves open optimal strategies pending larger studies.
This case series presents 6 patients with heart failure (HF) and preserved or mildly reduced ejection fraction who underwent atrial shunt implantation in a clinical trial evaluating its safety and efficacy. Shunt closure was considered in selected cases of worsening HF, particularly when shunt flow reversal was observed. Detailed hemodynamic evaluation revealed that shunt closure may have been detrimental in 5 cases and beneficial in only 1 case. Intentional closure of an implanted atrial shunt has not been previously reported; here, we describe the clinical decision-making process and outcomes based on comprehensive hemodynamic assessments, including pulmonary vascular dynamics and shunt flow patterns in such cases. These findings highlight the critical importance of thorough hemodynamic evaluation in patient management after atrial shunt placement in recognition of other factors that may play a role in the presence of the shunt. Additional research is needed to establish optimal management strategies for patients experiencing worsening HF after atrial shunt implantation.
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Yaku et al. (2025) conducted a case report in Heart failure with preserved or mildly reduced ejection fraction (n=6). Atrial shunt closure was evaluated on Hemodynamic outcomes of shunt closure. Hemodynamic evaluation of 6 patients with worsening heart failure after atrial shunt implantation suggested that intentional shunt closure may have been detrimental in 5 cases and beneficial in 1.
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