Percutaneous closure of ventricular septal defects. State of the art

Abstract

Ventricular septal defect (VSD) is the most common congenital heart disease. Surgery has been performed for many years and is considered to be the gold standard for the treatment of VSD. However, it is associated with morbidity and mortality. Percutaneous closure of VSDs is performed under general anesthesia and with fluoroscopic and transesophageal echocardiographic guidance. Two devices of the Amplatzer family are currently used to close percutaneously muscular and perimembranous VSD with a closure rate of 97% (incidence of major complication 2.2%) and 97.5% (major acute complications in 1.2%), respectively. Occurrence of complete atrioventricular block is reported in 1% of subjects. Acquired VSD can occur as post-surgical residual leak, as a traumatic event or as consequence of a myocardial infarction. There are few data about percutaneous closure of post-surgical residual VSD and of traumatic VSD. As for the surgical approach, in patients with post-myocardial infarction VSD success rate of percutaneous closure is around 88% with a mortality of 22%. The currently available data show that, in experienced hands, percutaneous closure is a safe and effective procedure. Device closure of muscular and perimembranous VSD is a real alternative to the standard surgical approach with the advantage of a significantly reduced rate of mortality and complications.