1. Transcatheter closure of postinfarction ventricular septal rupture
D. Seshagiri Rao, Amar Narayan Patnaik, Ramachandra Barik, Lalita Nemani, Akula Siva Prasad 
Journal of Indian College of Cardiology 
Volume 5, Issue 3, Pages (September 2015)
DOI: /j.jicc
Copyright © 2015 Indian College of Cardiology Terms and Conditions

2. Fig. 1
A rough sketch shows a) Femoro-fremoral arteriovenous loop with two significant bends (double S) on the way from right inferior vena cava to left ventricle. The first curve A offers significant kinking during sheath negotiation. The second curve is modified by location of ventricular septal defect, its size, size of ventricular aneurysm affecting the space available between free wall of right ventricle and anteriorly protruded aneurysmal sac. Larger the size of the anteroseptal wall aneurysm, it is more difficult to negotiate the stiff sheath because almost no space between right ventricle free wall and septal aneurysm in anterior wall myocardial infarction. b) If the patient larger aneurysm with more apically located VSD, it is very tough to negotiate the combo of sheath and dilator through femoral approach. Femorojugular arteriovenous loop has only one curve and helpful. The later loop was used in all the four cases without any difficulty in sheath manipulation with dilator or containing device.
Journal of Indian College of Cardiology 2015 5, DOI: ( /j.jicc )
Copyright © 2015 Indian College of Cardiology Terms and Conditions

3. Fig. 2
A – Left ventricular angiogram in LAXO (LAO 60–30°) to profile the number, location and size of the VSD for all the cases. B – PVSR was crossed from left ventricle (retrogradely) using 5Fr Amplatzer diagnostic catheter and exchange length 0.035″ Terumo wire (Terumo Medical Corporation, USA). C – Terumo wire was snared from right atrium or pulmonary artery using Amplatzer Gooseneck Snare Kit (EV3 Inc.). D. Sheath and dilator negotiation is an extremely crucial step because of mismatch between hardware and pathology of defect in these cases and should be guided by fluoroscopy and echocardiographic support to avoid extension of tear of VSD.
Journal of Indian College of Cardiology 2015 5, DOI: ( /j.jicc )
Copyright © 2015 Indian College of Cardiology Terms and Conditions

4. Fig. 3
A1 and A2 – Severe acute angle kinking of delivery sheath after dilator removal from sheath via transfemoral approach: The device was aligned across the defect but later anchoring failed. B – Successful device alignment and implantation. C – Successful device alignment and implantation in a case of residual leak closure after a year of surgical patch closure of PSVR. Sternal wires were seen on left side of reader. D – After sheath negotiation this patient developed ventricular arrhythmia and succumbed on table. E – Successful device alignment and implantation. F – ASD device of size 12 mm [Cardi-O-Fix] was implanted successfully with significant reduction of left to right shunt to 0.98:1.
Journal of Indian College of Cardiology 2015 5, DOI: ( /j.jicc )
Copyright © 2015 Indian College of Cardiology Terms and Conditions