Philipp Lurz and Saibal Kar discuss iatrogenic atrial septal defects from transseptal procedures. Small ones usually close on their own, while large defects causing significant shunting need closure to prevent right heart overload. Some moderate defects may be beneficial by decompressing the left atrium, so closure isn’t always needed. With the increasing amount of procedures, understanding the hemodynamics is also key to safe management.

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