Transcatheter Closure of Multiple Membranous Ventricular Septal Defects with Giant Aneurysms Using Double Occluders in Four Patients

Transcatheter device closure was performed under general anesthesia in all the patients. The interventional treatment modality was approved by the ethics committee of our hospital, and informed consent was obtained before the procedure. Femoral artery and vein was routinely punctured. Left ventricular angiography was performed at 60° left anterior oblique and 20° cranial tilt position. The entrance diameter of the septal aneurysm and the maximum exit diameter were measured. A proper domestic membranous septal occluder was selected according to anatomy feature of septal aneurysm. A cut pigtail catheter was carefully manipulated to pass through VSD into right ventricle, and 0.035 inch noodle wire was advanced into pulmonary artery or superior vena cava. The trapper was then advanced via the femoral vein to entrap the wire and pull it outside of the body to establish a femoral artery–vein loop (A‐V loop). The delivery sheath was advanced into left ventricle through A‐V loop, and then the first device was deployed from venous side. If control angiography and transthoracic echocardiography (TTE) showed incomplete closure and significant residual shunt (RS) which was difficult to be closed by another device replacement, the second occluder was tried to completely close the residual defects. We usually preferentially select Amplatzer Ductal Occluder II (ADO II) to close residual defect from arterial side. However, if the aneurysm cavity was large enough to accommodate another device, membranous septal occluder can also be considered. After satisfactory outcome confirmed by control angiography and TTE, the devices were released.