Patients with elevated filling pressures are at increased risk of adverse cardiovascular (CV) outcomes. Structural interventions to lower elevated either left or right atrial filling pressures are gaining attention. Studies in heart failure show that lowering left atrial pressure may reduce CV events while improving functional capacity. In recognition of this, trials are ongoing studying the effects of percutaneously implanted interatrial shunt devices (IASD). The preliminary results of IASD implantation suggest that periprocedural complications are rare and midterm safety good. Although both haemodynamic and functional parameters improve after IASD implantation, study designs, including sample size and duration, preclude definite conclusions regarding potential efficacy. In this paper, we briefly summarise current knowledge in the field, and give a perspective on the data needed to make interatrial device shunt therapy a part of our armamentarium in patients with heart failure or pulmonary hypertension and increased filling pressure.