Complex ventricular septal defects. Update on percutaneous closure.

UNLABELLED: Ventricular septal defects (VSDs) are the most common congenital heart diseases. Sometimes they can be complex because of anatomy, age of the patients or associated diseases. Surgery has been performed for many years and is considered as the gold standard for the treatment of VSD. However, it is associated with morbidity and mortality. Less invasive techniques have been developed in last 15 years. Two types of devices from the Amplatzer family are currently used to close percutaneously muscular and perimembranous VSD.

METHODS

Comparative data and technical aspects of percutaneous closure in complex congenital defects (muscular and perimembranous VSDs) and in acquired defects (residual post-surgery, traumatic and postinfarction) are presented and discussed in this review. Hybrid approach to VSD closure is another complex situation and it is presented, too.

RESULTS

Successful closure is obtained in around 95% with a rate of major complication of 5.3% for muscular VSD. For the perimembranous VSD, the complete and successful closure is reported in 97.5% of patients, while major acute complications occur in 1.2%. Occurrence of complete atrioventricular block is reported in 1.6% of subjects. Acquired VSD can occur as post-surgical residual leak, traumatic or postinfarction VSD. Procedures are usually complex and different techniques should be used.

CONCLUSIONS

Percutaneous closure of complex VSDs is possible, safe and effective procedure in highly specialized centers. Appropriate patient selection is of paramount importance to the success of the procedure.