We present the case of a 15-year-old male patient with a restrictive subaortic ventricular septal defect (VSD) and a large aneurysm protruding into the right ventricle that caused moderate tricuspid regurgitation (TR) (figure 1, video 1 of the supplementary data). In line with the latest guidelines, percutaneous treatment was selected, given the favorable anatomy (distance to aortic leaflets > 1cm).

Figure 1

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The procedure was performed under general anesthesia and was guided by transesophageal echocardiography (EPIQ system, Philips Healthcare, The Netherlands). Because the defect was 12.5mm in size (figure 1A), a 14-mm KONAR-MF device (Lifetech, China) was applied with a retrograde approach. Catheterization of the VSD was complicated by the size of the aneurysm. Accordingly, the EchoNavigator fusing imaging system was used. The echocardiographic projection comprised a 3-chamber view at 122° with left anterior oblique fluoroscopic projection at 42° and cranial at 18°. This obtained a good overlapping echocardiographic and fluoroscopic view of the VSD, which facilitated rapid catheterization (figure 2A; the blue arrow indicates the guidewire path; this figure is shown in color only in the online version of the article). Next, the guide catheter was advanced (figure 2B, the red arrow indicates the catheter path; video 2 of the supplementary data) and the device was deployed. All maneuvers were monitored via fusion imaging (video 3 of the supplementary data).

Figure 2

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The final outcome was excellent, without a residual shunt or complications and with an almost entirely resolved TR (figure 3, video 4 of the supplementary data). As far as we know, this is the first reported case of complex VSD closure with the KONAR-MF device and exclusively guided by fusion imaging.

Figure 3

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The patient's consent was obtained for dissemination of the case.