Transcatheter Closure Of Ventricular Septal Defects Research Articles

Feasibility of retrograde approach for percutaneous closure of ventricular septal defect under solely guidance of transesophageal echocardiography

To evaluate the feasibility of retrograde transcatheter closure of ventricular septal defects (VSD) under trans-esophageal echocardiography (TEE). Twelve patients with VSD, with 4 residual shunt, treated by transcatheter VSD closure under solely guidance of TEE were summarized. Mean age, body weight and average diameter of VSD in 12 cases were (11.58±6.57) years, (31.85±13.28) kg, (5.50±2.20) mm, respectively. All patients were treated by retrograde transcatheter closure under solely guidance of TEE. The post-operative efficiency was estimated by TEE immediately. Patients were followed up by echocardiography, X-ray examination and electrocardiogram at 24 hours, 1, 3 and 6 months after the procedures. All 12 patients were treated successfully under solely guidance of TEE. The diameter of devices were 5-14 mm. There were 1 case with trivial residual shunt after the procedures immediately. No patients suffered from residual shunt, occluder malposition, peripheral vascular injury and pericardial effusion during the follow-up. Percutaneous transcatheter closure of VSD completely guided by TEE is safe and effective. This method could avoid the radiation and contrast media reaction, and also could simplify the procedure.

Management of intractable hemolysis after transcatheter ventricular septal defect closure with Nit Occlud® Lê ventricular septal defect coil

Management of intractable hemolysis after transcatheter ventricular septal defect closure with Nit Occlud® Lê ventricular septal defect coil

Comparison of the Clinical Outcomes and Costs Between Transcatheter Device Occlusion and Surgical Closure for the Treatment of Isolated Ventricular Septal Defect

INTRODUCTION: The most common congenital heart disease (CHD) in childhood is ventricular septal defect (VSD), and the standard mode of treatment for defects that need correction is surgical closure under cardiopulmonary bypass. Advancements in technology are leading us into the era of percutaneous closure of VSDs. The current trend in the correction of CHD is to use techniques that would allow early hospital discharge and come with the least morbidity risk. The objective of this study was to compare the costs and the clinical outcomes of transcatheter device occlusion and surgical closure as modes of treatment for isolated VSD among pediatric patients of the Philippine Heart Center (PHC). METHODOLOGY: This was a prospective cohort study of pediatric patients who underwent either device occlusion or surgical closure of uncomplicated VSD in PHC from January 2014 to December 2014. Complications that occurred immediately after the procedure, during the hospital stay and one month after discharge were compared. The lengths of post-procedural hospital stays were likewise compared. Actual in hospital charges and costs of complications during the hospital stay were noted. RESULTS: All cases of VSD that were included in the study were closed successfully with no residual shunts for either group. The complications noted were blood loss requiring blood transfusion (22.6% for the surgical group, 12.9% for the device group), procedure-related infection (12.9% for the surgical group; 0% for the device group) and pneumothorax (12.9%, surgical group; 0%, device group). The mean post-procedural days were 4.7 for the surgical group and 1.2 for the device group (p<0.001); the mean post-procedural days for patients with complications in the surgical group was about seven days. There was a significant difference in the hospital and procedural costs between the two groups, i.e., the surgical group’s expenses were greater by ₱75,200.00 (p<0.001). CONCLUSION: The results of this study support the continued use of transcatheter occlusion as a treatment option for the closure of isolated VSD. KEYWORDS: ventricular septal defect, transcatheter closure of VSD.

Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects: The Mayo Clinic experience.

To determine event-free survival after transcatheter closure of ventricular septal defect (VSD), and to identify predictors of adverse events (AE) in post myocardial infarction VSD (post-MI VSD) subgroup. There are limited data on mid-term follow-up after transcatheter VSD closure. Retrospective review of 27 cases of transcatheter VSD closure (post-MI = 18 and non-ischemic = 9) performed from 1999 to 2013. We defined AE as death, device embolization, hemolysis requiring blood transfusion, heart block and reintervention. In the post-MI VSD subgroup, mean age and follow-up was 69 ± 11 and 7.3 ± 7 years, respectively. AE occurred in 8 (44%) patients (death-3, device embolization-1, hemolysis-1, surgical VSD closure-2, reintervention-1). Event-free survival was 56% at 1 month and 5 years, and all AE occurred in the periprocedural period. Cardiogenic shock (HR: 3.21, CI: 1.82-5.41, P = 0.002), and VSD closure in acute phase (HR: 2.14, CI: 1.12-4.31, P = 0.004) were independent predictors of AE. In the non-ischemic VSD subgroup, mean age and follow-up was 49 ± 15 and 8.7 ± 8 years, respectively. AE occurred in 3 (33%) patients (late death-1, surgical VSD closure-2). For the entire cohort, freedom from death was 89% and 85% at 1 month and 5 years, and event-free survival was 70% and 61% at 1 month and 5 years. Transcatheter closure of post-MI VSD carries a moderate risk of periprocedural complications but low event rates afterwards. By comparison, device closure of non-ischemic VSD has lower periprocedural morbidity but some patients continued to experience AE during follow-up.

Complete atrioventricular block after percutaneous device closure of perimembranous ventricular septal defect: A single-center experience on 1046 cases

Complete atrioventricular block (cAVB) has been deemed a rare complication after transcatheter closure for ventricular septal defect (VSD). However, this serious event appears to be underrecognized and is worth being investigated further. To determine the incidence and predisposing factors of cAVB associated with closure of VSD using a modified double-disk occluder (MDO). From December 21, 2001 to December 31, 2014, 1046 patients with perimembranous ventricular septal defect underwent percutaneous closure using the MDO. Electrocardiography was evaluated before the procedure, within 1 week after the procedure, and then at 1, 3, 6, and 12 months and every year thereafter. Other baseline and procedural parameters were also evaluated and a comparison between patients requiring pacemakers and those not suffering from cAVB was done. cAVB occurred in 17 patients (1.63%) after the procedure. Of the 17 patients, 8 underwent permanent pacemaker (PPM) implantation. The cAVB occurred within 30 days after the procedure in 14 patients and after 1 year in 3 patients. In comparison patients aged ≤18 years, patients aged >18 years were more prone to cAVB (P = .025). Logistic regression revealed no significant parameter to predict later requirement for PPM. The incidence of cAVB after transcatheter closure of VSD was acceptable, as part of the cAVB population recovered after administration of corticosteroid and application of a temporary pacemaker. Late cAVB (>1 year) appears to make it more difficult to restore normal conduction block. Because of the recurrence of cAVB, life-long follow-up with periodic electrocardiography examination may be mandatory.

Transcatheter closure of ventricular septal defect in patients with aortic valve prolapse and mild aortic regurgitation: feasibility and preliminary outcome

To evaluate the feasibility, safety and efficacy of transcatheter closure of ventricular septal defect (VSD) in patients with aortic valve prolapse (AVP) and mild aortic regurgitation (AR). Between January 2008 and July 2014, transcatheter closure of VSD was attempted in 65 patients. The total intermediate closure successful rate in all subjects was 96.9%. During the perioperative period, no death, major bleeding, pericardial tamponade, occluder dislodgement, residual shunt or hemolysis occurred. Two procedures had been forced to suspend due to significant aggregation of device related aortic regurgitation, three cases of transient complete left bundle branch block occurred but did not sustain. At 1-year follow-up, no patients had residual shunts and complications. Furthermore, grade of residual AR were relieved in 61.9% (39/63) cases and degree of AVP were ameliorated in 36.5% (23/63) patients; Transcatheter closure VSD in selected patients with AVP and mild AR is technically feasible and highly effective. Long term safety and efficacy needs to be assessed.

TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECT: RESULTS OF MIDTERM FOLLOWUP

There are limited data about transcatheter closure of ventricular septal defect (VSD). We present the largest single center cohort of transcatheter VSD closure in USA. We reviewed 28 patients (pt) with transcatheter VSD closure performed between 1999-2013 (Table/Figure). Indications included post

Transcatheter ventricular septal defect closure – A tertiary care center experience from South India

Transcatheter ventricular septal defect closure – A tertiary care center experience from South India

Follow-up of patients with interventional closure of ventricular septal defects with Amplatzer Duct Occluder II.

Nonsurgical closure of congenital ventricular septal defects (VSD) has become increasingly acceptable with the availability of different occlusion systems. Transcatheter device treatment is used for perimembranous and muscular defects. Atrio-ventricular block remains the most troublesome complication of device closure. The aim of this study was to describe our experience with closure of VSD using the Amplatzer Duct Occluder II (ADO II) as an "off-label" approach in children and adults. Between 2004 and 2012 transcatheter closure of 31 VSD (20 perimembranous, 10 muscular VSD and 1 ruptured sinus valsalva) with ADO II was undertaken in patients between 3 months and 55 years of age and with a body weight ranging from 4 to 105 kg in our institution. In 29 of 31 procedures, the defect was successfully closed (93.5%) without any significant complications. No increase of aortic or tricuspid valve regurgitation was found in any after procedure. Small residual shunts were observed immediately after the device implantation, but disappeared during a median follow-up period of 38 months (0.4-63) in 27 of 31 patients. There was no incidence of AV block or other conductance abnormalities during implantation or follow-up. The ADO II device is safe and effective for transcatheter VSD closure, but this is still an "off-label" use. After long-term follow-up in a large number of patients this device may be approved for VSD closure in the future.

Percutaneous closure of postinfarct muscular ventricular septal defects: A multicenter study in China

BackgroundSurgical repair is an effective method to treat ventricular septal defect (VSD) complicating acute myocardial infarction (AMI). However, the mortality rate remains high. This study was designed to assess the immediate and mid-term results of transcatheter closure of postinfarct muscular VSDs. MethodsData were retrospectively collected from 42 AMI patients who underwent attempted transcatheter VSD closure between 2008 and 2012 in seven heart centers of China. ResultsNine patients underwent emergent VSD closure in the acute phase (within two weeks from VSD) while the others underwent elective closure. The time between VSD occurrence and closure in emergency group and elective group was 7.7±2.3 days and 35±14.5 days, respectively (p<0.01). The percentage of procedure success in the emergency group and elective group was 77.8% (7/9) and 97% (32/33), respectively (p=0.048). The hospital mortality was higher for emergent closure in comparison to elective closure (66.7% vs. 6.1%, p<0.01). During a median follow-up of 25 months (0–58 months), two patients died at 8 and 29 months, respectively, and no serious complications occurred in other patients. ConclusionInterventional postinfarct VSD closure is a safe and effective approach that can be performed with a high procedural success rate, with favorable outcomes if it can be undertaken >14 days postinfarct.

Transcatheter Closure of Perimembranous Ventricular Septal Defects using Nit-Occlud® Lê VSD Coil: Early and Mid-Term Results

Our objective was to investigate the short- and mid-term results of transcatheter ventricular septal defect (VSD) closure with the Nit-Occlud(®) Lê VSD coil. Retrospective data collection study. Data were collected from 20 patients who underwent transcatheter VSD closure with the Nit-Occlud(®) Lê VSD coil device between October 2011 and June 2013. The mean age of the study subjects was 7.3 ± 4.0 years, and the mean weight was 25.7 ± 11.8 kg. The distance between the defect and the aortic valve, measured using angiography, was an average of 5.1 ± 2.0 mm, and the left ventricular opening averaged 8.2 ± 2.1 mm. The mean value of the Q p/Q s ratio was 1.7 ± 0.4. Intravascular hemolysis developed in the first few hours after the procedure in three patients. In one of these cases, despite medical treatment and the implantation of a detachable coil placed into the Nit-Occlud(®) device transcatheterly, hemolysis persisted. This device was removed and the VSD was closed surgically. In the other two cases, although the residual shunt persisted on echocardiography, the hemolysis regressed spontaneously. There were no rhythm problems or other complications during the follow-up period of 12.3 ± 6.6 months. In the selected cases, for the transcatheter treatment of VSD, the Nit-Occlud(®) Lê VSD coil device can be used. When compared with other VSD closure devices, there was no development of a permanent atrioventricular block, which is an important advantage. However, patients with a residual shunt should be monitored closely for the development of hemolysis during the first few hours.

Long-term efficacy of transcatheter closure of ventricular septal defect in combination with percutaneous coronary intervention in patients with ventricular septal defect complicating acute myocardial infarction: a multicentre study

To assess the immediate and long-term outcomes of transcatheter closure of ventricular septal defect (VSD) in combination with percutaneous coronary intervention (PCI) in patients with VSD complicating acute myocardial infarction (AMI). Data were prospectively collected from 35 AMI patients who underwent attempted transcatheter VSD closure and PCI therapy in five high-volume heart centres. All the patients who survived the procedures were followed up by chest x-ray, electrocardiogram and echocardiography. Thirteen patients underwent urgent VSD closure in the acute phase (within two weeks from VSD) while the others underwent elective closure at a median of 23 days from VSD occurrence. The percentage of VSD closure device success was 92.3% (36/39) and procedure success was 91.4% (32/35). The incidence of in-hospital mortality was 14.3% (5/35). At a median of 53 months follow-up, only two patients died at 38 and 41 months, respectively, and other patients' cardiac function tested by echocardiography improved significantly compared to that evaluated before discharge. The combination of transcatheter VSD closure and PCI for treating VSD complicating AMI is safe and feasible and is a promising alternative to surgery in patients with anatomically suitable VSD and coronary lesion.

The Circulating Level of Endothelial Progenitor Cells After Transcatheter Closure of Congenital Heart Disease in Children

Data have shown that circulating endothelial progenitor cells (EPCs) closely correlate with the vascular endothelial layer state. The present study was designed to describe the evolution of EPCs in children before and 24 h after transcatheter closure surgery for occluding congenital heart disease. Three groups of patients were studied: the transcatheter closure of atrial septal defect (ASD) group (group 1), the transcatheter closure of patent ductus arteriosus (PDA) group (group 2), and the transcatheter closure of ventricular septal defect (VSD) group (group 3). The circulating EPC level was detected using flow cytometry measuring CD34 and kinase insert receptor double-positive mononuclear cells. The concentration of vascular endothelial growth factor (VEGF) was assessed by enzyme-linked immunosorbent assay. The fluoroscopy time was correctly recorded during the surgery. All of the data were collected before and 24 h after surgery. EPC level and VEGF concentration did not change significantly before and at 24 h after surgery in groups 1 and 2. In group 3, the level of circulating EPCs and VEGF concentration increased significantly 24 h after surgery. The fluoroscopy time in group 3 was significantly longer than in groups 1 and 2. The increased volume of EPCs and VEGF were positively correlated in group 3. Our results showed that transcatheter closure of PDA and ASD in children does not lead to increased circulating level of EPCs. Transcatheter closure of VSD may result in vascular endothelium injury as indicated by increased circulating EPC level.

EComment. Percutaneous closure of post-myocardial infarction septal defect

We read with great interest the paper by Papalexopoulou et al. regarding the best timing of surgery in patients with post-infarct ventricular septal rupture [1]. After carefully reviewing the literature, the authors conclude that the best strategy is to delay the surgery by 3-4 weeks if the haemodynamic status of the patient allows. However, current guidelines advocate immediate surgical closure of the ventricular septal defect (VSD) irrespective of the patient's haemodynamic status to circumvent further haemodynamic decline [2]. First described by Lock et al. in 1988, the transcatheter closure of VSD has gained a widespread use, and devices originally intended to close the patent foramen ovale or atrial septal defects, have been modified for closure of muscular VSD. This less-invasive interventional approach allows, in the majority of cases, rapid haemodynamic stabilization by reducing the left-to-right shunt [3]. Anatomical considerations, best depicted by echocardiography, represent a major limitation of this procedure. Large VSDs exceeding 35 mm, apical VSDs without suitable rim or basal VSDs in the vicinity of mitral apparatus or the aortic valve represent a contraindication to the percutaneous closure with Amplatzer devices [4]. Another important drawback is the limited number of centres with sufficient expertise in performing these challenging procedures, because percutaneous closure of an acute postinfarct VSD remains one of the most demanding procedures in interventional cardiology. Costache et al. used an Amplatzer occluder as a bridge-to-surgical procedure in a 79-year old woman in cardiogenic shock secondary to a post-infarct VSD [5]. The combined approach enabled them to perform surgery on a more stable patient. Recently, Thiele et al. [4] evaluated, in a prospective study, the outcomes of primary interventional closure of postinfarction VSD in an acute setting as an alternative to surgical closure. The overall 30-day mortality of this less-invasive approach was 35%. Not surprisingly, the mortality rate was higher in patients with cardiogenic shock. Major complications occurred in 41% and these included free ventricular wall rupture, device embolization or dislocation and residual left-to-right shunting. Despite advances in medical and surgical care intervention, mortality of postinfarction VSD remains high, especially in patients with haemodynamic compromise. Future multicentre studies are warranted to identify patients best suited for surgical or interventional closure, in the era of evolving alternative technologies. Conflict of interest: none declared

Lung Compliance and Airways Resistance in Healthy Neonates

Traditionally, closure of ventricular septal defects (VSDs) has been a surgical procedure, however in 1988 Lock et al. [1] ushered in the era of percutaneous ventricular septal defect closure when they reported on the results of transcatheter VSD closure using the Rashkind double umbrella device in six patients with congenital and acquired VSDs. These investigators also reported on the technique of using an arteriovenous wire loop as part of the closure that is still in use today. Since their initial report, multiple devices other than the Rashkind device have been used to close VSDs including devices that are specifically designed for this purpose. Percutaneous VSD closure has therefore become an acceptable alternative to surgical closure of muscular, traumatic, postoperative residual and post-infarct VSDs. Transcatheter device closure remains controversial for perimembranous VSDs however secondary to the risk of heart block. The purpose of this paper is to report on the current status of percutaneous closure of VSDs.

Patent Foramen Ovale Closure

Setting aside the controversial questions of whether closing a patent foramen ovale (PFO) is indicated or effective for the prevention of recurrent stroke or the treatment of migraine headaches, what is the physiological impact of implanting a transcatheter device in the atrial septum? In this issue of Circulation , Wohrle and his colleagues address 1 aspect of this question, reporting the results of a study in which they assessed atrioventricular and semilunar valve function in 102 patients before and after transcatheter PFO closure.1 The authors evaluated valvar competence before, the day following, and 12 months after PFO closure and found no significant change in aortic regurgitation (AR) or regurgitation of the other cardiac valves. On their own, these findings might be passed off as predictable and modestly novel. Viewed in the context of a recent article by Schoen et al in Heart , however, they are noteworthy.2 Accordingly, to appreciate the study by Wohrle et al fully, it should be read as a counterpoint to the report by Schoen et al, which was a surprise to many in its description of new or increased AR in 10% of 170 patients who underwent transcatheter closure of a PFO and 9% of 70 in whom a device was placed to close an atrial septal defect.2 Article see p 3002 Before simply accepting the apparently contradictory findings of these 2 studies, however, it is worth acknowledging several basic methodological differences. The first difference is the means by which valvar regurgitation was assessed. In contrast to Schoen et al, who evaluated valvar function with transesophageal echocardiography 3, 6, and 12 months after catheterization, Wohrle et al assessed the function of the aortic and other valves with cardiac magnetic resonance imaging. Schoen et al graded AR according to a standard ordinal scale, …

Immediate primary transcatheter closure of postinfarction ventricular septal defects

Immediate surgical repair of ventricular septal defect (VSD) complicating acute myocardial infarction is associated with high mortality. Percutaneous device closure appears to be safe and effective in patients treated for a residual shunt after initial surgical closure, as well as in patients with a chronic post-infarct VSD. Primary transcatheter VSD closure in the acute setting may also offer advantages over surgery. Between September 2003 and February 2008, 29 consecutive patients underwent primary transcatheter VSD closure. Clinical, procedural, and outcome data were collected. Patients were divided into those with and those without cardiogenic shock at presentation for risk stratification. The median follow-up time of surviving patients was 730 days. The median time between VSD occurrence and closure was 1 day [interquartile range (IQR) 1-3] and the initial procedural success rate was 86%. The shunt (Qp:Qs) could be reduced from 3.3 (IQR 2.3-3.8) to 1.4 (IQR 1.2-1.7; P < 0.001). Procedure-related complications such as major residual shunting, left ventricular rupture, and device embolization occurred in 41%. The overall 30-day survival rate was 35%. Mortality was higher for cardiogenic shock in comparison to non-shock patients (88 vs. 38%, P < 0.001). Interventional acute VSD closure is a promising technique that can be performed with a high procedural success rate and may offer an alternative to surgery. Despite the less invasive technique, mortality of postinfarction VSD remains high, particularly in patients with cardiogenic shock. Further developments in devices and delivery techniques are required.

Transcatheter Closure of Perimembranous Ventricular Septal Defect Using a Modified Double-Disk Occluder

This multicenter study assessed the efficacy and safety of transcatheter closure of perimembranous ventricular septal defect (VSD) using a modified double-disk occluder. In 5 different centers in China, 412 patients with VSD, including 202 men and 210 women, underwent attempted transcatheter closure. The age range was 3 to 65 years (mean 16.4+/-9.1). The diameter of defect was 3 to 15 mm by transthoracic echocardiography and 3 to 18 mm by left ventriculography. The ratio of pulmonary to systemic flow varied from 1.6 to 2.3 (1.9+/-0.4). The device diameter was 4 to 20 mm (7.09+/-3.60). The ventricular septal rim below the aortic valve was 0 to 5 mm. The immediate success rate was 96.6%; 6 cases had third degree atrioventricular block and recovered within 3 weeks. None needed a permanent pacemaker. Dislodgement of the device occurred in 3 patients but the device was recaptured and redeployed in 2 cases. During the follow-up period of 2 years, there was no evidence of residual shunt and device-related complications. In conclusion, transcatheter closure of VSD is safe and effective in most selected patients; the mid-term prognosis of patients with transcatheter closure is good.

Clinical Use of Electrocardiography in Adults With Congenital Heart Disease

The prevalence of adult congenital heart disease (ACHD) has risen markedly over the past 2 decades, with the number of adults now rivaling the number of children with severe defects.1 This is, perhaps, not surprising given that current care allows nearly 90% of infants born with heart defects to thrive into their adult years.1,2 This remarkable triumph is tempered, however, by the realization that early interventions were reparative and not curative. Numerous complications may surface years after uneventful childhood courses, justifying vigilant clinical follow-up throughout adulthood. The 12-lead ECG remains an invaluable cornerstone in the clinical appraisal of adults with congenital heart disease that, in certain circumstances, provides diagnostic and/or prognostic information. The present review imparts a clinical perspective to ECG interpretation in ACHD, emphasizing practical and pathogenomonic findings in the more frequently encountered congenital defects in adults. Anatomic features of the conduction system relevant to ECG findings in ACHD are summarized, including variations in the location of the sinus node, atrioventricular (AV) node, and His-Purkinje system. Thereafter, pertinent ECG features are highlighted for common subtypes of ACHD (Table). Examples are provided throughout for illustration. View this table: Table. Typical ECG Features in Common Forms of ACHD ### Sinus Node In the morphologically normal heart, a crescent-shaped sinus node is characteristically located epicardially along the lateral aspect of the superior cavoatrial junction. It generates a P-wave axis typically between 15° and 75°. Most patients with ACHD have normally positioned atrial chambers, called atrial situs solitus, with normal sinus node location. The position of the sinus node may, however, vary with the atrial chambers and their appendages. #### Juxtaposition of the Atrial Appendages In juxtaposition of the atrial appendages, both appendages are on the same side of the arterial pedicle rather than each being ipsilateral to its respective atrium. Left juxtaposition, with left-sided atrial appendages, frequently accompanies tricuspid atresia and has …

Percutaneous transcatheter ventricular septal defect closure in adults with Amplatzer septal occluders

Background — The interest in transcatheter ventricular septal defect (VSD) closure is continuously growing. Therefore, we report our experience in perimembranous (Pm) and postinfarction (Pi) VSD closure.Methods — All patients, older than 16 years, were selected from a data base, in which Pm and Pi VSDs were registered.The patients’ files were reviewed until the most recent follow-up date.Results — Nine (7 male, 37.4 ± 12.8 y) and 8 (6 male, 76.3 ± 6.2 y) patients underwent a Pm (group A) and Pi VSD (group B) closure, respectively. One female patient was treated for a posttraumatic VSD (26 y). In group A, 7 patients were closed with the Amplatzer perimembranous VSD occluder, one with the muscular VSD occluder, and one patient with the atrial septal defect occluder. All patients in group B were treated with the muscular VSD occluder. In the post-traumatic VSD an Amplatzer patent foramen ovale occluder was used. Device implantation was feasible in all, except in two patients with extremely large VSDs (one Pm and one Pi VSD).Total transcatheter closure or small residual leakage was achieved in 7/8 patients in group A, but one patient needed surgical VSD repair because of massive haemolysis, another patient died 9 months later. A small or moderate shunt was present immediately after the procedure in all patients of group B. No device-related complications were reported, but all, except one patient, died within 2 weeks after the procedure because of an extremely high co-morbidity (logistic Euroscore 70 ± 25%). Total closure was achieved in the post-traumatic VSD.Conclusion — Transcatheter closure of Pm and Pi VSD with Amplatzer septal occluders in adults is feasible and safe, but the post-procedural prognosis totally depends on the aetiology of the VSD and its co-morbidity.