The surgical anatomy and treatment of interatrial communications

Holes permitting shunting between the atrial chambers can take various anatomical forms, varying from the patent oval foramen, which shunts only from right-to-left, to the so-called sinus venosus defect, which is associated with anomalous connection of the pulmonary veins. Our review deals with all forms of interatrial communications, except for the so-called 'primum' defect, since although the lesion produces interatrial shunting of blood, the atrioventricular septal defect with common atrioventricular junction but separate valvar orifices for the right and left ventricles, is strictly an atrioventricular septal defect. In addition, the review illustrates in detail the morphological features of interatrial communications, and describes surgical challenges and approaches.