Fig. 4

Different steps of perventricular device closure of a small doubly committed ventricular septal defect (DCVSD). a A small DCVSD (arrowhead) located at the 1 to 2 o’clock position in the parasternal short-axis view on transthoracic echocardiography. b The delivery sheath (arrowhead), which was perpendicular to the septum, was loaded with the device and passed through the defect. c The left disk was opened with its platinum marker (arrow) pointing towards the apex. While maintaining gentle tension on the cable without rotation, the delivery sheath was withdrawn to deploy the right disk of the device into the right ventricle. d The eccentric occluder was placed in a proper position without affecting the aortic and pulmonary valves. (AV = aortic valve, PV = pulmonary valve)