Antegrade or retrograde catheterization across a ventricular septal defect.

The success rate and the most suitable catheter tip for crossing over various types of ventricular septal defects (VSDs) were examined as a preliminary study for transcatheter closure of VSD. The 18 consecutive patients with various types of VSD were aged from 1 to 95 (mean [+/- SD] 13 +/- 22) months. Body weight was 3.7 to 25.0 (8.0 +/- 5.1) kg. Two-dimensional echocardiography showed that the maximal diameter of the defects ranged from 1.0 to 12.0 (7.5 +/- 3.1) mm. There were 10 patients with perimembranous defects, 4 with outlet defects, 2 with muscular defects, and 2 with tetralogy of Fallot with perimembranous defects. An angiographic balloon catheter, or an original or modified Judkins right coronary catheter could be passed through the VSD antegradely or retrogradely in 16 of 18 patients. In only two patients, with a small VSD of 2.0 and 1.0 mm, the catheter could not cross over the defect. The catheter entered the ascending aorta antegradely in 12 cases. The Judkins right coronary catheter is most suitable for crossing a VSD either antegradely or retrogradely.