(A) Left ventricular angiogram demonstrating a large apical muscular VSD. The VSD is crossed retrograde from the LV using a Judkins right catheter and a soft tipped wire which is advanced into the main pulmonary artery. The wire is snared in the main pulmonary artery from a right internal jugular vein approach and externalized forming an arteriovenous wire loop.
(B) The delivery sheath is advanced from the RIJV through the VSD and into the LV. The wire is removed. (C) The defect is measured using transesophageal and angiographic measurements and a device 1-2 mm larger than the defect is chosen and advanced through the sheath and deployed across the VSD.
(D) The device is released from the delivery system and a repeat angiogram demonstrates appropriate placement of the device within the defect.