Complex ventricular septal defects. Update on percutaneous closure.

Area of Science:

• Cardiology
• Congenital Heart Disease
• Interventional Cardiology

Background:

• Ventricular septal defects (VSDs) are the most common congenital heart diseases, sometimes presenting with complex anatomical features, patient age considerations, or associated conditions.
• Surgical VSD closure, while the gold standard, carries risks of morbidity and mortality.
• Minimally invasive percutaneous techniques have emerged as alternatives over the past 15 years.

Purpose of the Study:

• To review and discuss the technical aspects and comparative data of percutaneous VSD closure.
• To evaluate the efficacy and safety of percutaneous closure for both congenital (muscular, perimembranous) and acquired VSDs.
• To present the hybrid approach for complex VSD closure.

Main Methods:

• Review of comparative data and technical aspects of percutaneous closure for muscular and perimembranous VSDs.
• Inclusion of data on percutaneous closure for acquired VSDs (post-surgical residual, traumatic, postinfarction).
• Discussion of the hybrid approach for complex VSD closure.

Main Results:

• Successful closure rates of approximately 95% for muscular VSDs with a 5.3% major complication rate.
• Successful closure rates of 97.5% for perimembranous VSDs with only 1.2% major acute complications.
• Complete atrioventricular block reported in 1.6% of patients; acquired VSDs often require complex, tailored techniques.

Conclusions:

• Percutaneous closure of complex VSDs is a feasible, safe, and effective option when performed in specialized centers.
• Meticulous patient selection is critical for achieving successful procedural outcomes.
• The review highlights the advancements in percutaneous closure for various VSD types.