Transcatheter closure of intracardiac shunts

In the last decade percutaneous transcatheter techniques and devices for closure of intracardiac defects have considerably improved. Transcatheter ASD closure has become a routine procedure in many centers. It is technically feasible in about 80% of the patients with a secundum type defect. The success rate today is higher than 99% and the rate of any complication below 0.5%. The advantages compared to surgery are the avoidance of a thoracotomy, postoperative pain and morbidity. The length of hospital stay is much shorter and most often general anesthesia is not necessary. Patent foramen ovale has been recognized as a potential cause of paradoxical embolism and embolic stroke particularly in younger patients. Transcatheter closure has recently gained popularity since several studies demonstrated a reduced rate of recurrent strokes after device closure. The occlusion is technically relatively simple and can be performed with ASD closure devices or with devices modified according to the anatomy of the foramen ovale. Catheter closure has certain advantages compared with life-long anticoagulation. For some patients this is the only therapeutic option. Nevertheless, there is still a need for randomized studies. Catheter closure of ventricular septal defects is possible today in selected patients. There are devices available specifically designed for muscular defects, for perimembraneous defects and subaortic ventricular septal defects.