ABC | Volume 111, Nº2, August 2018

Case Report Santos et al Traumatic VSD Closure with ASD Occluder Arq Bras Cardiol. 2018; 111(2):223-225 Figure 1 – Echocardiographic images of the VSD. Panel A: VSD located in the mid anteroseptal segment. Panel B: VSD measuring 19 mm on the LV side and 7 mm on the RV side. Panel C: continuous wave Doppler estimating peak gradient at 84 mmHg. Figure 2 – 10 mm ASD Occluder deployed in the VSD. Panel A: position of the device in the VSD. Panel B: LV angiogram showing mild residual shunt. Panel C and D: TEE displaying the residual shunt through the superior edge of the device. During his stay our patient was clinically improving, which led to our decision to delay the intervention. Furthermore, it is known that in VSDs fibrotic tissue facilitates the device placement in elective closures. 2 However, the progressively increasing shunt, led to the decision of closing it. He was initially considered for surgery, but given the risks associated this procedure, the alternative approach was pondered. Transcatheter closure can be a successful substitute with some advantages. It removes cardiopulmonary bypass, avoids arrhythmogenic scar formation related with ventriculotomy and reduces hospital stay and recovery time. Because these are rare cases with diverse features, it can be challenging to size accurately the defect. In this case, imprecise echocardiographic measurements and the difficulty in operating the sizing balloon catheter, led to the inappropriate choice of the first device. A possible complication of selecting this type of devices is the appearance of hemolysis. The probable mechanism is the passage of high-velocity turbulent blood flow through 224