PEDIATRIC CARDIOLOGY
PERCUTANEOUS CLOSURES
It was again William Rashkind who, after drilling a hole, decided to close it. Around the mid eighties, he designed a device for closure of arterial ducts and then another device for treatment of atrial septal defects. These techniques have now reached maturity.
Closure of the arterial duct using coils or occluding devices has become the standard treatment modality.
Closure of atrial septal defects has become a routine procedure over the past 3 or 4 years.
The limitations of this technique have been progressively overcome especially in cases of large defects. This strategy is indicated in the treatment of ostium secundum type atrial septal defect with right-to-left shunt and of patent foramen ovale with evidence of a right-to-left shunt. This technique is associated with an excellent outcome and complete closure of the defect in the vast majority of cases. Though longer follow-up is still required, acute and mid-term complications are rare occurrences.
Closure of ventricular septal defects is now routinely performed. Congenital defects can be of a muscular nature and closure can be successfully carried out with various devices, except in the case of multiple defects, or defects involving atrio-ventricular valves.
Thanks to the current development of specific devices, peri-membranous defects next to the aortic valve will soon be amenable to percutaneous closure.
