{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T04:51:25Z","timestamp":1767761485973,"version":"3.48.0"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Atrial septal defect (ASD) closure in patients with bidirectional or right\u2010to\u2010left shunts presents significant challenges regarding indications, procedure, and follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study on 47 patients undergoing percutaneous ASD closure with right\u2010to\u2010left or bidirectional shunts, analyzing clinical features, procedural details, and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median age was 10.2 years (IQR: 6.2\u201314.1), and weight was 30.9\u2009kg (20.8\u201350.4). Desaturation (89.4%) was the main indication, with bidirectional (48.9%) or fixed right\u2010to\u2010left shunts (40.4%). Eight patients (16%) were NYHA class III\u2013IV. Diagnoses included pulmonary hypertension (12.8%), restrictive RV physiology (44%), RV outflow tract obstruction (27.7%), tricuspid regurgitation streaming (6.4%), and elevated RA pressure due to tricuspid valve stenosis (8.5%). Median NT\u2010pro\u2010BNP was 1155\u2009pg\/mL (827\u20131692). ASD size on TOE was 11\u2009mm (7.2\u201314.7); balloon sizing and occlusion were used in 25.5% and 12.8%, respectively. RA and RV pressures remained stable post\u2010closure. First\u2010attempt closure succeeded in 81.1%, mostly with the Amplatzer Septal Occluder (65.9%), oversized by 4\u2009mm. Three early deaths (6.4%) were recorded: 2 with RV failure and Potts shunt in pulmonary hypertension and one from device embolization causing a major stroke. Median hospital stay was 2 days. Over a median 4.7 years follow\u2010up (1.86\u201310.6), RV function was normal in 83.7%. Reintervention rates were 4.5% (percutaneous) and 11.3% (surgical). One late death and one transplantation occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Percutaneous closure of atrial septal defects offers favorable outcomes even in high\u2010risk patients, despite inherent concerns. Careful patient selection and tailored procedural strategies are essential for optimizing results in this population at risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70349","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T19:28:40Z","timestamp":1763666920000},"page":"288-296","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous Closure of Atrial Septal Defects With Bidirectional or Right\u2010to\u2010Left Shunts"],"prefix":"10.1002","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6043-655X","authenticated-orcid":false,"given":"Alessia","family":"Callegari","sequence":"first","affiliation":[{"name":"Centre de R\u00e9f\u00e9rence Malformations Cardiaques Cong\u00e9nitales Complexes\u2010M3C, H\u00f4pital Universitaire Necker\u2010Enfants Malades, Assistance Publique\u2010H\u00f4pitaux de Paris Paris 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