Anatomo-functional characterization of interatrial septum for catheter-based interventions

Secundum Atrial septal defect (ASD) and Patent foramen ovale (PFO) is becoming the most popular field of interest for catheter-based interventions. While there is a common agreement about the management of ASD patients, there is no complete agreement on which is the best management of PFO patients. In PFO patients, the real challenge for the clinician, beside secondary prevention of recurrent stroke, is to understand which the higher risk patients to refer for treatment are and which is the proper device to use. In this setting, the anatomo-functional characterization of interatrial septum seems to be of paramount importance for both ASD and PFO, not only for the device selection but also for therapeutic decision-making. In the present review the author overviews the main anatomic a functional characteristics of interatrial septum, obtained with the current available diagnostic tools, such as transcranial Doppler, transthoracic and transesophageal echocardiography and intracardiac echocardiography, and discusses the impact of such characteristics on catheter based closure.