case_images: PMC11193337_01
case_images: Transesophageal echocardiogram showing the ventricular septal defect (arrow) in deep transgastric short-axis view (1) and mid-esophageal 4-chamber view (2) (LV: left ventricle; RV: right ventricle).
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case_images: A transesophageal echocardiogram was performed which showed a similarly described VSD (Figure 1).
case_images: Anterior-posterior caudal view showing patent left main and left circumflex arteries with severe mid-left anterior descending artery disease (arrow).
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case_images: He subsequently underwent a right and left heart catheterization, which showed 99% mid-left anterior descending (LAD) artery stenosis with a thrombotic lesion and 100% right coronary artery (RCA) stenosis with visualized collaterals along with a step up in oxygen saturation from 56% in the right atrium to 74% in the RV (Figures 2-4).
case_images: Right anterior oblique cranial view showing severe subtotal occlusion of the left anterior descending artery with filling defect consistent with thrombotic occlusion (arrow). Left to right collaterals are visualized as well.
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case_images: PMC11193337_01_10.1177_23247096241262514-fig3.jpg
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case_images: He subsequently underwent a right and left heart catheterization, which showed 99% mid-left anterior descending (LAD) artery stenosis with a thrombotic lesion and 100% right coronary artery (RCA) stenosis with visualized collaterals along with a step up in oxygen saturation from 56% in the right atrium to 74% in the RV (Figures 2-4).
case_images: Left anterior oblique view showing chronic total occlusion of right coronary artery (arrow).
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case_images: PMC11193337_01_10.1177_23247096241262514-fig4.jpg
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case_images: He subsequently underwent a right and left heart catheterization, which showed 99% mid-left anterior descending (LAD) artery stenosis with a thrombotic lesion and 100% right coronary artery (RCA) stenosis with visualized collaterals along with a step up in oxygen saturation from 56% in the right atrium to 74% in the RV (Figures 2-4).
case_images: The double-patch technique for ventricular septal perforation shown in a heart cross-section (LV: left ventricle; RV: right ventricle).
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case_images: The patient subsequently underwent double-patch closure of VSD (Figure 5) as described in the literature by Tabuchi et al,   exclusion of LV pseudoaneurysm, and CABG with saphenous vein graft to the first diagonal branch.
case_images: Apical 4-chamber view of transthoracic echocardiogram showing the area of double-patch repair (arrows) of the ventricular septal defect (1) with the Doppler image showing no blood flow through the interventricular septum (2) (LV: left ventricle; RV: right ventricle).
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case_images: TTE showed an EF of 30%, successful double-patch closure, and no interventricular blood flow (Figure 6). The patient improved clinically over the course of the following week and was discharged home on appropriate medical therapy along with a wearable defibrillator for the prevention of sudden cardiac death.