case_images: PMC4322405_01
case_images: Right ventriculogram in lateral view [Video 1] shows thickened and doming pulmonary valve (PV) shown in arrow, dilated main pulmonary artery (MPA) and adequately open right ventricular outflow tract (RVOT)
case_images: APC-8-59-g001.jpg
case_images: PMC4322405_01_APC-8-59-g001.jpg
case_images: F1
case_images: Right ventriculogram showed thickened and doming pulmonary valve; infundibulum showed dynamic systolic infundibular clamping, but opened well in diastole [Figure 1 and Video 1].
case_images: Left ventricular (LV) injection [Video 2] after deploying Amplatzer duct occluder (ADO I) shown in arrow across the muscular VSD
case_images: APC-8-59-g002.jpg
case_images: PMC4322405_01_APC-8-59-g002.jpg
case_images: F2
case_images: Amplatzer Duct Occluder (StJude Medical, St Paul, MN) from the right ventricle after establishing an arteriovenous circuit [Figure 2 and Video 2]. After release, the RV pressure increased transiently due to dynamic infundibular hyper-contractility and the retention skirt of the device partially protruded into the left ventricle [Figure 3 and Video 3].
case_images: Migration of the device [Video 3] into the left ventricle (LV) after release of the device (ADO I). Ao =Aorta, RV = right ventricle
case_images: APC-8-59-g003.jpg
case_images: PMC4322405_01_APC-8-59-g003.jpg
case_images: F3
case_images: Amplatzer Duct Occluder (StJude Medical, St Paul, MN) from the right ventricle after establishing an arteriovenous circuit [Figure 2 and Video 2]. After release, the RV pressure increased transiently due to dynamic infundibular hyper-contractility and the retention skirt of the device partially protruded into the left ventricle [Figure 3 and Video 3].
case_images: After positioning a muscular VSD occluder device (MVO) across the VSD from the right ventricle [Video 4], the device appears tilted towards the left ventricle (LV)
case_images: APC-8-59-g004.jpg
case_images: PMC4322405_01_APC-8-59-g004.jpg
case_images: F4
case_images: The device was replaced with an 18-mm muscular VSD occluder (HeartR, Lifetech Scientific, Shenzhen, PRC) [Figure 4 and Video 4].
case_images: The device (arrow) appeared well-aligned on the right ventricular (RV) side [Video 5]. MPA = Main pulmonary artery
case_images: APC-8-59-g005.jpg
case_images: PMC4322405_01_APC-8-59-g005.jpg
case_images: F5
case_images: Even though device appeared tilted towards the left ventricle on left ventriculogram, right ventriculogram showed correct device orientation [Figure 5 and Video 5].
case_images: Temporary pacing wire (TPI) in right ventricle (RV) while embolized device was snared from the left ventricle (LV) [Video 6]
case_images: APC-8-59-g006.jpg
case_images: PMC4322405_01_APC-8-59-g006.jpg
case_images: F6
case_images: There was transient heart block needing temporary RV pacing [Figure 6 and Video 6].
case_images: The large device was slenderized by screwing the cable to the device again from a brachial access catheter. The non-screw end of the occluder was snared from a femoral artery catheter [Video 7]
case_images: APC-8-59-g007.jpg
case_images: PMC4322405_01_APC-8-59-g007.jpg
case_images: F7
case_images: The large device was slenderized by re-screwing this cable [Figure 7 and Video 7].
case_images: Through a jugular venous access, a larger muscular VSD occluder device was positioned across the defect. The VSD device was held by a snare at the left ventricular (LV) end from the femoral arterial catheter [Video 8]. This helped stabilization of the device from both ends and permitted successful deployment
case_images: APC-8-59-g008.jpg
case_images: PMC4322405_01_APC-8-59-g008.jpg
case_images: F8
case_images: This stabilization of the device from both ends permitted successful deployment [Figure 8 and Video 8].