An overview of device closure of ventricular septal defects using the Amplatzer devices

University of Chicago Children's Hospital, Pritzker School of Medicine, Chicago, Illinois, USA
Ralf Holzer, Ziyad M. Hijazi

1. Background and history
Ventricular septal defects (VSD) are the most common congenital cardiac anomalies, accounting in isolation for almost 20% of congenital cardiac lesions.¹⁾ Ventricular septal defects have also been reported after myocardial infarction, trauma as well as residual defects after prior attempts at surgical closure.
Depending on size, VSDs can cause variable degrees of left-to-right shunting with or without pulmonary hypertension. Small muscular defects diagnosed in infancy have a high likelihood of spontaneous closure, whereas larger defects tend to persist through adulthood. The likelihood of spontaneous closure decreases with advancing age and is less common for defects located within the perimembranous region of the ventricular septum. Irrespective of the hemodynamic effects of VSDs there is an additional risk of developing subacute bacterial endocarditis.
Surgical closure has been advocated as the gold standard for treatment of large VSD's. Surgical closure of perimembranous VSD's yields excellent results with low morbidity and mortality. However, the outcome is less favorable in patients with increased surgical risk factors, multiple previous cardiac surgical interventions, poorly accessible muscular VSDs or “Swiss-cheese” type VSDs.
In 1988 Lock and colleagues reported the first experience of transcatheter closure of muscular VSD's in 7 patients using the Rashkind double umbrella device. Since then different devices have been used to close muscular as well as perimembranous. VSD's with variable success, such as the Clamshell/CardioSeal device, the buttoned device as well as detachable coils. Since 1998 different types of Amplatzer devices have been used to close VSD's.
Table 1 illustrates all larger series (including more than 5 patients) of transcatheter VSD device closure reported in the literature to date. Results using the Amplatzer VSD devices were promising as these devices were specifically designed for closure of VSD's.
Devices for closure of VSD's have not only been used in the cardiac catheterization laboratory. In 1993 Fishberger and colleagues first reported intraoperative
VSD device closure using the Rashkind double umbrella device in 10 patients. More recently Bacha and colleagues reported perventricular device closure of muscular VSDs without cardiopulmonary bypass, using the Amplatzer mVSD device in 6 patients.

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