Directly ventricular septal defect closure without using arteriovenous wire loop: Our adult case series using transarterial retrograde approach

We read with great interest the article by Pekel et al. (1) titled “Directly ventricular septal defect closure without using arteriovenous wire loop: our adult case series using transarterial retrograde approach” published in the Anatolian Journal of Cardiology in this issue. Ongoing progress in the interventional techniques has now made the transcatheter closure of anatomically selected ventricular septal defects (VSDs) feasible with satisfactory results and low morbidity and mortality rates (2–5). The procedure is routinely performed by passing a guidewire through the defect to the right heart chambers and snaring of the device out of the venous access (the arteriovenous looping or antegrade approach). Subsequently, the delivery system and device are advanced and deployed through the venous site (2). In their study, Pekel et al. (1) presented their experience of the transcatheter VSD closure without using the standard AV loop and have suggested a transarterial approach. However, the approach was used in a limited number of patients with favorable anatomy and therefore cannot be generalized to all VSD closure procedures. Few previous studies have reported successful results with retrograde VSD closure in children using symmetrical VSD occluder devices (2, 4). It should be considered that further limitations might be encountered in adult populations