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Although remarkable achievements have been made in the medical treatment of <jats:styled-content style=\"fixed-case\">PAH<\/jats:styled-content>, there is a role for invasive or surgical procedures in patients with progressive disease despite optimal medical therapy or with no access to such therapy. Atrial septostomy creates a right\u2010to\u2010left intracardiac shunt to decompress the overloaded right ventricle. Despite significant advances to validate and improve this palliative procedure, as well as recent reports of improved outcomes, it is only slowly being adopted. This article aims to detail the history, indications, contraindications, procedural techniques, and outcomes of atrial septostomy. We will also shed light on some of the newer interventions, inspired by the same physiological concept, that are being evaluated as potential palliative modalities in patients with <jats:styled-content style=\"fixed-case\">PAH<\/jats:styled-content>.<\/jats:p>","DOI":"10.1002\/clc.22398","type":"journal-article","created":{"date-parts":[[2015,3,2]],"date-time":"2015-03-02T20:31:16Z","timestamp":1425328276000},"page":"395-400","source":"Crossref","is-referenced-by-count":26,"title":["Atrial Septostomy: A Contemporary Review"],"prefix":"10.1002","volume":"38","author":[{"given":"Hayan","family":"Al Maluli","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Cardiology Division Temple University Hospital  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"DeStephan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Temple University Hospital  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Ren\u00e9 J.","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiology Division Temple University Hospital  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Sandoval","sequence":"additional","affiliation":[{"name":"Cardiopulmonary Department National Cardiology Institute Ignacio Ch\u00e1vez  Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,3,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1966.03100240125026"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.55.5.449"},{"key":"e_1_2_7_4_1","first-page":"100","article-title":"Comparison of the hemodynamics and survival of adults with severe primary pulmonary hypertension or Eisenmenger 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