PMC6450237_01
(a) Two-dimensional transthoracic apical four-chamber zoom view focusing the posterobasal ventricular septal defect. (b) Two-dimensional transthoracic apical four-chamber view on color Doppler shows the left-to-right shunt. (c) Three-dimensional transthoracic apical four-chamber view images show ventricular septal defect and allow its sizing
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F1
A bedside Echo revealed a posterobasal VSD, measuring 12 mm x 9 mm on three-dimensional (3D) echo, with left-to-right shunting, and pulmonary hypertension (pulmonary artery systolic pressure [PASP] = 60 mmHg) [Figure 1a-c].
Fluoroscopic images before (a) and after (b) implantation of a 26-mm Amplatzer atrial septal occluder
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F2
Amplatzer atrial septal occluder on the delivery sheath was advanced via RV into the VSD [Figure 2a and b]. A partial occlusion of VSD with a significant reduction of the ventricular shunt was obtained.
Two-dimensional transthoracic apical four-chamber view images acquired 6 days after percutaneous closure: a 26-mm Amplatzer atrial septal occluder correctly placed (a) and mild residual interventricular shunt on color Doppler (b)
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F3
Echocardiographic evaluation [Figure 3a and b] performed 6 days later confirmed a correct apposition of the device with just trivial residual shunt and decreased PASP (30 mmHg).