**8.3 Percutaneous device closure**

Device closure of VSDs is an alternative for some residual defects, centrally located muscular defects and those not amenable to surgery such as apical muscular defects [34]. Various devices have been used to close VSDs, since its initial description by Rashkind in the 1970s [35]. Since then, several devices including the Amplatzer muscular and membranous VSD occluders, Nit-occlud, and duct occluders I and II are being used for different types of VSD [36]. At this time, only the Amplatzer muscular VSD occluder has received approval for clinical use by the Food and Drug Administration (FDA) and others devices are used on "off-label" basis. Within a year

of device placement, up to 92% of patients achieve complete closure of the muscular VSDs. Complications, although rare, include device embolization or malposition, valve regurgitation, residual shunt, hemolysis, arrhythmias, tamponade, cardiac perforation, and death [32]. Nit-occlud devices are associated with residual shunt when compared to other devices. Transient and permanent atrioventricular block is the most serious complication reported with device closure, especially with closure of perimembranous defects [37]. However, more recent studies have reported success of device closure of VSD may depend on patient selection as well as the distance of VSD to aorta and tricuspid valve [36]. The newer ADO II devices are being used in younger patients with perimembranous or muscular VSDs. In a single center trial, lesser complication rates with good success were reported [38]. However, longer, multicenter, prospective data is needed to establish the safety and efficacy.
