ABSTRACT
Transcatheter closure of ventricular septal defects (VSDs) is a very complex procedure. It has a greater potential for a wide range of complications that are common to all extensive intracardiac manipulations. There are more intracardiac manipulations and a higher complexity of manipulations, with the multiple exchanges of wires, sheaths, catheters, snares, and devices, than with any other interventional procedure. The avoidance of complications is the best guarantee against complications. This includes best possible monitoring of patients during the procedure, a good choice of catheter materials, a cool head, a delicate hand, and – last but not least – the readiness to abandon the procedure in insecure or uncertain situations. The shape (Figure 19.1) of the PFMVSD coil (PFM
Company, Cologne, Germany) is much more flexible than that of the Amplatzer Occluder (AGA Medical, Golden Valley, MN). This flexibility of its design and shape allows a better adaptation of the coils to the anatomy of the individual defect. This is reflected in the fact that VSD closure using the coils, unlike the Amplatzer Occluder, has led to no significant arrhythmic disorders.1-4 The application of coils demands, however, appreciable clinical experience, and highly skilled operators. In general, the preparation for closure procedures with coils is comparable with that of the application of umbrella-like implantations. The preparation for a VSD closure – before the coil
deployment itself can begin – must entail several steps. First, complications can even occur in this preparation phase,which may aggravate the procedure from the very start, and in some cases even prevent the coil implantation. In the preparation phase it is important to take an angiogram of the left ventricle with the best profile of the defect. This not only serves to depict the size of the VSD, but also determines the plausibility of ‘crossing’ the defect. It should be kept in mind that, even in this preparation phase, severe heart rhythm disorders can be evoked – even atrioventricular (AV) block. Injuries of the right coronary artery can especially ensue in cases of membranous defects. Repetitive passages of the aortic valve with the guide wire or catheter can sometimes lead to injury of the aortic valve.
