Update on percutaneous and perventricular device closure of congenital ventricular septal defect

ABSTRACT

Introduction

Ventricular septal defect is the most common congenital heart defect. Surgical repair has been standard therapy for symptomatic ventricular septal defects since the 1950s. Catheter-based device closure of ventricular septal defects emerged in the 1980s and has become a safe and effective alternative in select patients.

Areas Covered

This review focuses on patient selection and procedural techniques for device closure of ventricular septal defects, including percutaneous and hybrid perventricular approaches. The available devices used for these procedures and outcomes of their use are reviewed.

Expert Opinion

Percutaneous and perventricular device closure of ventricular septal defects is safe and effective in select patients. However, the majority of ventricular septal defects requiring closure continue to be managed with conventional surgery. Further development and investigation of transcatheter and hybrid surgical approaches for closing ventricular septal defects is required.

KEYWORDS:

• Ventricular septal defect
• device closure
• perventricular
• hybrid
• congenital heart disease
• interventional cardiology

Article highlights

• Worldwide, at least eight different families of devices, totaling several dozen different unique devices, are approved for transcatheter VSD closure; many other devices are used off-label for VSD closure.

• Transcatheter VSD closure has been performed safely in babies as small as 1.8 kg and is performed predominantly in muscular- and perimembranous-type VSD.

• Potential complications of transcatheter VSD closure include heart block, tricuspid and aortic valve injury resulting in iatrogenic regurgitation, incomplete defect closure, device embolization, and vascular injury.

• Risk factors for complications include small patient size, perimembranous defects, and device size relative to defect size.

• Head-to-head studies comparing transcatheter VSD closure and surgical VSD repair are limited but suggest similar outcomes and risks.

• Hybrid perventricular VSD closure can be performed safely in select cases using a combination of surgical and catheter techniques to minimize the risks and optimize the outcome compared with conventional surgical or transcatheter approaches.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.