title: Transcatheter closure of perimembranous ventricular septal defects using umbrella devices.
abstract: There is only limited experience of interventional closure of perimembranous ventricular septal defects (pmVSDs), particularly on the long-term follow-up. This is a report on our long-term results after transcatheter closure of pmVSDs using the Cardioseal, Starflex, or Rashkind devices.
  
  
  METHODS
  Between 1993 and 2005, we performed interventional occlusions of pmVSDs in 18 patients. The size of the defect ranged between 4 and 8.5 mm, Q(p)/Q(s) was calculated between 1.3 and 2.2. Except for two, the patients had no other structural heart defect. In the early days, we used the Rashkind PDA occluder (17 mm) in seven, followed by the Cardioseal device (17 mm) in nine, and the 23 mm Starflex device in two patients.
  
  
  RESULTS
  Interventional closure of the defects was performed successfully in all patients without any complication during the procedure. Fluoroscopy times were 11.8-53.7 min (median 28.65 min). We achieved a complete closure in 13 patients, three patients with recently implanted devices still show minimal shunting. In two patients the occluder had to be removed surgically because of embolization into the pulmonary artery and significant residual shunting resulting in severe hemolysis in the second patient. In long- (mean 10.7 years) and short-term (mean 0.85 years) follow-up we have not observed any hemolysis, arrhythmias, device dislocations, or device-related aortic or tricuspid regurgitation.
  
  
  CONCLUSIONS
  Transcatheter closure of small pmVSDs using non-selfcentering devices can be performed successfully. Long-term follow-up investigations show encouraging results. Complications like device-embolization and significant residual shunting occur in the presence of large defects and/or concomitant malformations.
authors.affiliation: Department of Paediatric Cardiology, The Children's Heart Center St Augustin, St Augustin, Germany. rp.handke@t-online.de
authors.forename: Ronald
authors.initials: R
authors.lastname: Handke
authors.forename: Christian
authors.initials: C
authors.lastname: Jux
authors.forename: Dietmar
authors.initials: D
authors.lastname: Schranz
authors.forename: Martin
authors.initials: M
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome