Fig. 3

Sequential TEE and illustration images of transthoracic minimally invasive closure of an arch penetrating aortic ulcer (PAU). A TEE shows the PAU. B A delivery sheath was introduced through the defect and positioned with its tip in the ascending aorta. C Occluding device was delivered through the prepared loading sheath and delivery sheath. The left ventricular disc was deployed first by pushing the cable forward and then rotated until the disc advanced to the opposite side of the aorta thoracica. D An ASD occluder was advanced along the sheath. When the true lumen-to-false lumen shunt disappeared, the device was deployed. There was no significant residual shunt