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

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.