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Ventricular septal defects (VSDs) are the most common congenital heart malformations seen in children. Because spontaneous closure occurs frequently, patients with small VSDs should be followed clinically with no limitations except endocarditis prophylaxis. Surgical closure is recommended for only small defects with significant associated lesions such as aortic regurgitation, aortic valve prolapse, right or left ventricular outflow obstruction, tricuspid regurgitation, left ventricle to right atrial shunt, or recurrent endocarditis. Enlarging left ventricular size or deteriorating left ventricular function would also be an indication for surgical repair. Moderate and large VSDs in infancy often require treatment of congestive heart failure with diuretics, digitalis, and afterload reduction. Surgical closure before 9 months of age is indicated for large VSDs and by 2 years of age for moderate shunts to prevent pulmonary vascular obstructive disease and the consequences of long-standing volume overload. Device closure of VSD is still in the investigational stage but holds promise for treatment of apical or multiple muscular VSDs.

To report the use of Gianturco coils in non-surgical closure of patent ductus arteriosus (PDA).Retrospective review of patient data.Two specialist paediatric cardiology units in Riyadh, Saudi Arabia, and Cape Town, South Africa.Thirty children (median age 36 months, weight 12.5 kg) and one adult (24 years old) with PDA underwent attempted transcatheter closure of the duct between August 1994 and February 1995.Assessment of duct closure as measured angiographically or with colour flow Doppler techniques after insertion of a Gianturco coil or coils.Total occlusion was achieved in 90% of patients. In 2 patients accidental embolisation of the coil occurred during the procedure. The coils were easily retrieved with a snare retrieval device. The median diameter of PDA occluded was 2.5 mm. Between 1 and 6 coils were used to achieve occlusion. The median procedure time was 79 minutes. Seventy-nine per cent of patients in Riyadh were handled as day cases.Anterograde transcatheter occlusion of a small to moderate PDA with Gianturco coils is safe and effective. The technique is considerably less expensive than the Rashkind double umbrella.