A middle-aged man presented with symptoms of shortness of breath and fatigue. An echocardiogram found an enlarged heart chambers and a complex ventricular septal defect with a pseudoaneurysm. Angiography revealed a 3+ shunt. A transcatheter device was used to close the VSD, with the device tucked just below the aortic valve to cover the pseudoaneurysm, resulting in minimal residual shunting.

1. Complex VSD with
Pseudoaneurysm in scuba diver
Luft MD

2. Complex VSD with
pseudoaneurysm in a
middle aged man.
Chamber enlargement
noted by echo.
Symptoms of DOE and
fatigue.
3+ angiographic shunt.

3. Very high membraneous VSD by TEE

4. Easily crossed with JR4 and glidewire

5. Wire snarred in right IJ and externalized; AV rail created

6. Delivery of 10mm VSD device (note inferior aspect of pseudoaneurysm)

7. LAO RAO

8. Device tucked into PA just below AV with minimal residual shunting (angio shows we’re clearly
below the aortic valve)

9. Final LVG

10. Deep diver (over 100ft regularly and would NOT stop) with PFO and
>2mm gap at rest and 5mm with valsalva

11. PFO closure with 25mm
Amplatzer cribiform
occluder.

14. Final cine in LAO cranial and RAO caudal views