Transcatheter VSD Closure by Different Devices

Defects are classified according to their location within the septum (muscular, perimembranous, or supracrystal). The most common type is the perimembranous VSD (around 70%).
Indications for VSD closure are symptoms of heart failure, signs of left heart chambers volume overload, or a history of endocarditis. In patients with a volume overload of the left heart, closure is necessary to prevent pulmonary arterial hypertension, ventricular dysfunction, and arrhythmias.
The surgical approach is considered to be the gold standard, but it is associated with morbidity and mortality and the use of CPB . Percutaneous techniques have been developed to reduce the impact of such drawbacks of surgery. The attractiveness of percutaneous closure lies in the avoidance of cardiopulmonary bypass and sternotomy, a shorter hospital stay, and decreased cost.
The most significant complication is complete atrioventricular block (4-5%). The only variable significantly associated with the occurrence of this complication was age at the time of the procedure. In contrast, iatrogenic complete heart block after surgical VSD closure occurs in less than 1%. Equally, periventricular device closure of VSDs without cardiopulmonary bypass (CPB) under trans esophageal (TEE) or epicardial echocardiography guidance yields a low risk for rhythm disorders.
Different devices have been used for transcatheter VSD closure: AMPLATZER perimembraneous or muscular VSD occluders, Cardio -SEAL devices. Other devices have been used "off-label" to close muscular as well as perimembranous VSDs, including the buttoned device, detachable coils and the Amplatzer Septal Occluder.
However, these devices as well as the approved Cardio-SEAL device were designed for different indications and as such are not generally adapted to suit the very different anatomical and morphological parameters (such as septal thickness) that are encountered with muscular VSDs