Transcatheter closure of intracardiac shunts

Since the first attempts in the 70's, transcatheter closure of secundum atrial septal defects has evolved, and has become an effective alternative therapy for most patients with secundum ASD. The initial rigid and large devices became softer and thinner, thanks to dramatic structural improvement. The technique for transcatheter closure has greatly improved with time, as well as the indications and limits. Nowadays, percutaneous device closure is a well-accepted alternative to surgery, even as first-intention treatment for the majority of secundum septal defects. The rate of major complications is low and transcatheter closure carries numerous advantages as compared to surgery. Transcatheter ventricular septal defect has also become an invaluable tool as an alternative to surgery. More often percutaneous closure represents an additional therapy to close apical defects unsuitable for surgical closure. Because this complex transcatheter procedure may be poorly tolerated in very young children, perventricular hybrid closure may sometimes be more appropriate. Regarding perimenbranous ventricular septal defects, transcatheter closure is now abandoned in France because of an elevated rate of complete atrioventricular block. Finally, long-term follow-up of any patient undergoing transcatheter closure of intracardiac shunt is mandatory since information on long-term outcome after such intervention is lacking. (C) 2011 Elsevier Masson SAS. All rights reserved.