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

Figure 2

(a) Cross-sectional echocardiogram in the long axis parasternal view for a 21-year-old female patient showing a significant subaortic stenosis with broad-based fibromuscular ridge below a perimembranous subaortic VSD with about 20% aortic override. (b) Color flow imaging from the long axis parasternal view demonstrates the location of the defect with left-to-right shunt and long broad-based subaortic ridge with peak systolic pressure gradient of 36 mmHg across the LVOT and mild-to-moderate AR. (c) Parasternal long axis 2D echocardiographic image demonstrates the aortic disc of ADO-I; 10–8 mm (red arrow) was pulled towards the subaortic fibromuscular ridge (green arrow) and VSD (yellow arrow). (d) Parasternal long axis 2D echocardiographic image with color flow mapping demonstrates excellent position of the device closing the VSD and compressing the ridge against the interventricular septum (IVS) with mild AR. The peak systolic pressure gradient across the LVOT decreased to 17 mmHg. (e) Left ventricular angiogram in the left anterior oblique (70°) and cranial (30°) projection demonstrates a small-sized subaortic perimembranous VSD with a mild aortic override of approximately 20%. The peak systolic pressure gradient across the LVOT was 31 mm Hg. (f) Aortogram in the left anterior oblique (60°) projection revealing a prolapse NCC with mild-to-moderate AR (yellow arrow). (g) Left ventricular angiogram in the left anterior oblique (70°) and cranial (30°) projection demonstrating no residual shunt across the VSD and obvious aortic override. (h) Aortogram in lateral (90°) and cranial (20°) projections demonstrating proper device position with trivial AR. The peak systolic pressure gradient across the LVOT declined to 12 mmHg.

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