Objectives
Perforated sinus of valsalva (PSOV), is usually congenital but the successful attempt to close the acquired PSOV following AVR in a high risk surgical candidate opened the possibility for transcatheter closure of PSOV.

Material & Methods
The procedure was attempted in 14 patients, who were either not willing or were high risk candidates for surgical correction. The age range was 12 to 48 years, and all were in NYHA class III or IV. Echocardiography revealed rupture from right coronary sinus into right ventricle (RV) in 9 and non-coronary sinus into right atrium (RA) in 5. The estimated size of the defect was 6-12 mm. The defect was crossed retrogradely from the aortic side and an arteiovenous guidewire circuit was established. After balloon sizing, devices were successfully deployed by antegrade venous approach (Rashkind umbrella device in 2 and Amplatzer septal or ductus occluders in 12).

Results
There was complete abolition of shunt in 12, while 2 had residual shunt. One patient with residual shunt developed haemolysis, and was taken up for re-intervention but continued to have haemolysis, while the second was readmitted with IE. Both these patients were referred for surgical correction, which was done successfully. On follow-up of 4 to 146 months, there was no device embolisation and aortic regurgitation. One patient died of progressive congestive heart failure.

Conclusions
Transcatheter closure in a selective group of patients is safe and effective. Definitely, it has the advantage of obviating open heart surgery, but complete occlusion is mandatory to prevent complications.