Transcatheter Device Closure of Intracristal Ventricular Septal Defects

Transcatheter closure of ventricular septal defects (VSDs) is now offered as primary therapy at many institutions. We sought to evaluate the clinical feasibility and safety of device closure of intracristal VSDs using perimembranous occluders. A total of 49 patients were diagnosed with intracristal VSDs and assigned to the intracristal VSD group, and another 49 patients with the same size perimembranous VSDs were selected and assigned to the perimembranous VSD group. Two types of perimembranous occluders, symmetric and asymmetric, were used, and no difference was found between the groups with respect to successful closure. The diameter of the intracristal VSD was 3 to 10 mm (mean 5.8 ± 1.4) on the transthoracic echocardiogram. The procedure time and fluoroscope time in the intracristal VSD group were significantly greater than those in the perimembranous VSD group. More defects with a subaortic rim ≤2 mm on the transthoracic echocardiogram were present in the intracristal VSD group than in the perimembranous VSD group; thus, more asymmetric occluders were used in the intracristal VSD group. All devices remained in a stable position and in an optimal shape during follow-up. In conclusion, transcatheter closure of intracristal VSDs with the perimembranous occluder is feasible, safe, and effective.