Fig. 1

Sequential TEE as well as illustration images of perventricular device closure of doubly committed subarterial VSD. Panel a: TEE showed the VSD, surgical incision was made and a pledgetted mattress suture placed around the chosen puncture site in right ventricle. Panel b: A 20-G needle was inserted into the right ventricular cavity and a flexible 0.035-inch guidewire was introduced into the left ventricle through the defect. Panel c: A double-lumen delivery sheath was advanced into the left ventricle over the guidewire, and then the inner sheath was removed. Panel d: Occlude device was delivered through the prepared loading sheath and the delivery sheath. The left ventricular disc was deployed first by pushing the cable forward and then rotated until the eccentric side of the left disc toward the opposite side of the aortic valve. Panel e: The right disc of the device was then deployed by pushing the device cable. Ao: aorta; LV: left ventricle; RV: right ventricle