Clinical Images

Percutaneous Closure of a Poorly Tolerated Ventricular Septal Defect After Triple Valvular Prosthesis Surgery

Leire Unzue, PhD, MD1;  Eulogio García, MD1;  Belén Díaz-Antón, MD2;  Pilar Agudo3

Leire Unzue, PhD, MD1;  Eulogio García, MD1;  Belén Díaz-Antón, MD2;  Pilar Agudo3

J INVASIVE CARDIOL 2019;31(6):E154.

Key words: angiography, transcatheter aortic valve implantation, transesophageal echocardiogram


Percutaneous closure of ventricular septal defects (VSDs) is a feasible and effective treatment, especially in post-surgery defects, where patients requiring a reoperation may carry a high surgical risk. We describe the case of an 81-year-old woman with three biological prostheses at the aortic valve (AV), mitral valve (MV), and tricuspid valve (TV) with recurrent hospitalizations due to heart failure. Her treatment course is detailed in Figures 1 and 2 and Videos 1-3.

Post-surgery VSDs used to be located in the high part of the interventricular septum, resembling congenital perimembranous VSDs. This anatomical configuration makes it especially advisable to use a wire-maintaining technique while device positioning in order to achieve an accurate alignment of the device with the defect.

To the best of our knowledge, this is the first percutaneous closure of VSD in the presence of three valvular prostheses.

View the Supplemental Video here.


From 1Interventional Cardiology and 2Cardiac Images, HM Hospitales-Hospital Unversitario HM Montepríncipe, Madrid, Spain; and 3Clinical Cardiology HM Hospitales-Hospital Universitario HM Madrid-Norte Sanchinarro, Madrid, Spain.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted November 28, 2018.

Address for correspondence: Leire Unzue, MD, Hospital Universitario HM Montepríncipe, Av. de Montepríncipe, 25, 28660 Boadilla del Monte, Madrid, Spain. Email: leireunzue@yahoo.es

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