PMC3996184_01
PMC3996184_02
Intraoperative transesophageal echocardiography pre and after device implantation. A. Intraoperative transesophageal echocardiography demonstrating an important left to right shunt and B. Intraoperative transesophageal echocardiography demonstrating non residual left to right shunt after the device implantation.
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F1
Transesophageal echocardiography was used in tandem to guide direct needle puncture of the right ventricular free wall, taking care to avoid right coronary marginal branches (Figure 1A). No residual shunt were detected immediately after the procedure (Figure 1B).
Technical aspects of the preventricular device implantation technique. A. Insertion of the device, opening of the first hemiumbrella on the left side of the ventricular septal defect. B. Opening of the right hemiumbrella on the right side of the ventricular septal defect. C. Insertion of the delivery system through the anterior wall the right ventricle. D. The device already positioned and removal of the delivery system. Legend: Ao-Aorte, PA-Pulmonary artery, SCV-Superior Cava Vein, LV-Left ventricle, RV-Right ventricle
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F2
A puncture site perpendicular to the plane of the VSD was selected (Figure 2C). When the delivery system was under the aortic valve, we opened the first hemiumbrella (Figure 2A) and we found the right place for opening the second disk controlling both tricuspid and aortic valve (Figure 2B). The patch was compressed into the double umbrella device (Figure 2D).