Percutaneous Closure of a Large, Complex Postinfarct Ventricular Septal Defect.

OBJECTIVE: To describe a ventricular septal defect (VSD) repair via transseptal approach using a venovenous rail. KEY STEPS: Using a venous access, a transseptal puncture was made, and an Agilis sheath and JR4 catheter in mother-daughter configuration was advanced to the left ventricle (LV) over an extra-small Safari wire. Next, a Glidewire was advanced from the LV to the right ventricle (RV), then snared in the pulmonary artery and externalized via contralateral groin, after which it was exchanged for an Amplatz wire. A 9-F sheath was advanced from the RV to the LV over the wire. An 18-mm VSD occluder was then deployed. The 7-mm waist was partially opened in the LV, then retracted to expose the RV disc, after which it was well deployed. POTENTIAL PITFALLS: Creation of a venovenous rail carries the risk of iatrogenic atrial septal defect with bidirectional shunting and worsening tricuspid regurgitation. TAKE-HOME MESSAGE: Transseptal transcatheter repair of a VSD after myocardial infarction is a safe and effective option for select patients, especially when arteriovenous loop creation has significant risks.