Transcatheter coil occlusion of perimembranous ventricular septal defects

OBJECTIVES: Our purpose was to determine the feasibility and safety of transcatheter coil occlusion of a perimembranous VSD. BACKGROUND: Transcatheter coil occlusion of a perimembranous ventricular septal defect (VSD) may be a useful treatment; however, there are few reports on its technical aspects and outcome. METHODS: We attempted coil closure of a perimembranous VSD in 41 patients. We approached the VSD via the right ventricle (RV) in 16, via the left ventricle (LV) in 16, simultaneously deployed two coils from the RV (RV/RV) in three, and simultaneously deployed two, three, or four coils from the RV and LV (RV/LV) in six. Coils (0.038'' flipper, 0.052'' Gianturco, or 0.035'' platinum coil) were placed into the defect through the delivery catheter until any flow through the VSD disappeared or became trivial on angiography. RESULTS: We achieved 100% complete closure in all patients in whom coils were deployed, although some patients required a second session. A flipper coil used alone was insufficient to completely occlude VSDs larger than 2.5 mm. CONCLUSIONS: Transcatheter coil occlusion of a VSD can be performed reliably and safely by selecting appropriate embolic coils. Small defects (<2.5 mm) can be closed with a flipper coil, but defects >or=2.5 mm require a 0.052'' coil.