A middle-aged man presented with symptoms of dyspnea on exertion and fatigue. Echocardiography revealed an enlarged heart chambers and complex ventricular septal defect with a pseudoaneurysm. Angiography showed a 3+ shunt. A 10mm ventricular septal defect device was used to close the defect, tucking it into the pseudoaneurysm and reducing residual shunting. The man was also a deep scuba diver found to have a patent foramen ovale over 2mm at rest and 5mm with valsalva, which was closed using a 25mm Amplatzer cribiform occluder.

1. Complex VSD with Pseudoaneurysm
and PFO 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

5. Easily crossed with JR4 and glidewire

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

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

8. LAO RAO

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

10. Final LVG

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

12. PFO closure with 25mm
Amplatzer cribiform
occluder.

15. Final cine in LAO cranial and RAO caudal views