In previous review articles in this series entitled “Opening up”, John Gibbs gave a detailed account of interventional procedures performed to remove the obstacles often observed in congenital heart disease.^1,2 The objective of this review is to describe in detail the more recent but equally useful techniques implemented in order to close and occlude congenital heart defects and vessel connections.

To begin with I would like to pay tribute to William Rashkind, Jim Lock, and Kurt Amplatz for their fundamental contributions to the progress achieved in this field.

PATENT DUCTUS ARTERIOSUS

Transcatheter closure of patent ductus arteriosus was the first “closing” interventional procedure to be performed routinely. This procedure constituted a significant step forward in the percutaneous treatment of congenital heart disease and was initially developed by Porstmann in the late 1970s. It was William Rashkind who pioneered this technique after designing³ the Rashkind PDA occluder which consists of a double umbrella of stainless steel and polyurethane foam, introduced through a long sheath from the pulmonary artery.³ The next method to be most widely implemented involved the use of coils. At first simple pushed coils were used with a relatively high rate of embolisation. When embolisation occurs, coils hindering flow in a pulmonary branch must be retrieved by means of a snare. Such a retrieval manoeuvre can be long and difficult.

Then gradual technical improvements, and especially the development of detachable coils, allowed closure of large arterial ducts, using several coils if necessary.⁴ This technique is safe and particularly efficient in small ducts (fig 1A). However, the most spectacular progress has been the duct occluder developed by Kurt Amplatz.⁵ Like the other occluding devices he developed, it is made of a mesh of Nitinol (memory metal, a nickel-titanium alloy). It can be pushed inside a relatively small …