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

Figure 3

(a) Cross-sectional echocardiogram in the long axis parasternal view of a four-year-old male patient demonstrates perimembranous subaortic VSD (upper arrow) distal to the subaortic ridge (lower arrow). (b) Parasternal long axis 2D echocardiographic image with the color flow mapping demonstrating significant left-to-right shunt across the defect (arrow) with the subaortic ridge. (c) Echocardiographic parasternal long axis view shows ADO-I (10–8 mm) closing the defect and compressing the subaortic ridge against the IVS. (d) Parasternal long axis 2D echocardiographic image with color flow mapping demonstrating the optimum device position with neither residual shunt nor AR. (e) Echocardiographic subcostal view demonstrating proper position of ADO-I closing the defect and compressing the subaortic ridge against the IVS with patent LVOT. (f) Modified subcostal 2D echocardiographic image with color flow mapping demonstrating ADO-I closing the defect and compressing the subaortic ridge against the IVS with no residual shunt, patent LVOT, and no AR. (g) Left ventriculogram in the left anterior oblique (70°) and cranial (20°) projection demonstrates a small-to-moderate size subaortic VSD (upper arrow) with a filling defect below the VSD that represents the subaortic ridge (lower arrow). The peak systolic pressure gradient across the LVOT was 16 mmHg. (h) Left ventriculogram in the left anterior oblique (70°) and cranial (20°) projection documents good device deployment with no residual shunt. (i) Aortogram in lateral (90°) and cranial (20°) projection, demonstrating no AR despite prolapse of the NCC. The peak systolic pressure gradient across the LVOT decreased to 10 mmHg.

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