Transcatheter closure of ventricular septal defects using the Rashkind device: Initial experience

Abstract

We report our initial experience with transcatheter closure of ventricular septal defects (VSD) using the Rashkind device. Transcatheter closure of 25 VSDs was attempted in 16 patients with a median age of 2 (range 0.1–4) years and a median weight of 11 (range 4.1–19) kg. The location of the VSDs was apical in 14, midmuscular in 8, and anterior muscular in 3. Five patients had complex heart lesions, 10 patients had associated defects, including perimembranous VSD, atrial septal defect, patent ductus arteriosus, and coarctation of aorta. The remaining patient had isolated multiple muscular VSDs. The surgical repair of VSDs was a high‐risk option in all the patients. Of the 25 attempted closures, 22 devices were placed successfully. Nine patients had a single device, four patients had two devices each and one patient had a total of five devices placed. In two patients attempts to close three VSDs were associated with major problems/death. Fourteen patients have been followed up for at least 1 year and all are doing well. Five patients, who otherwise remain asymptomatic, have a trace residual shunt. The fluoroscopy time ranged from 51 to 205 min (median 110) and the procedure time 120 to 300 min (median 200). The transcatheter closure of VSDs acts as a palliation as well as a definitive therapeutic modality in some patients with surgically inaccessible VSDs. Deployment of multiple devices in a patient is feasible. Increased experience may diminish the initial rate of complications. Cathet. Cardiovasc. Intervent. 46:43–48, 1999. © 1999 Wiley‐Liss, Inc.

Follow-Up of Patients with Interventional Closure of Ventricular Septal Defects with Amplatzer Duct Occluder II

“…Moderate success was achieved with initially large delivery systems and devices, where residual shunting, induction of regurgitation of the valves (tricuspid and aortic valve), as well as arrhythmia and hemorrhage were dangers [15,27]. A transcatheter approach for the treatment of congenital heart diseases is appreciated by patients and their parents because of its lesser psychological impact (absence of a skin scar), shorter hospital time, less pain and discomfort, and avoidance of admission to an intensive care unit [8].…”

Transcatheter Device Closure of Congenital and Postoperative Residual Ventricular Septal Defects

“…8 -10 To date, published reports of this approach are limited to small series with relatively limited follow-up. [11][12][13][14][15][16][17][18][19] Since 1989, 168 patients with unrepaired congenital VSDs and postoperative residual VSDs have undergone transcatheter closure with successive generations of STARFlex-type devices as a part of approved regulatory trials. A subset of this experience was used to obtain FDA approval of the second-generation CardioSEAL device for closure of specific VSDs (NMT Medical Inc).…”

Transcatheter Closure of Muscular Ventricular Septal Defect Using the Amplatzer Devices

“…A combination of surgical and transcatheter approach sometimes is necessary in managing this group of patients. 6,16 Transcatheter approach has the advantages over surgery with the avoidance of surgical scar, a shorter hospital stay and avoidance of a potential complication from cardiopulmonary bypass. A careful selection of patients with detailed assessment of the defect and its surrounding structures using transoesophageal echocardiogram before the procedure, and appropriate device selection is important to avoid possible complications such as device embolization.…”