A Novel Approach for Transcatheter Management of Perimembranous Ventricular Septal Defect with a Subaortic Ridge

Figure 1

(a) and (b) Parasternal long axis 2D echocardiographic images of a 10-year-old female patient with a moderately sized perimembranous subaortic VSD with mild prolapse of RCC and subaortic stenosis (fibromuscular ridge 2 mm below the defect) with a systolic pressure gradient across the LVOT of 35 mmHg. (c) Color flow imaging from the long axis parasternal view demonstrates the location of the defect with a left-to-right shunt and a long and thick subaortic ridge. (d) Modified parasternal long axis echocardiographic image with color flow mapping demonstrates ADO-I (10–8 mm) closing the defect and compressing the ridge against the IVS without residual shunt or AR. The peak systolic pressure gradient decreased to 14 mmHg.

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