(A) Left ventricular angiogram demonstrating a perimembranous VSD. The defect is sized using angiography and TEE. The defect is crossed retrograde from the LV similar in a similar fashion to that described for Fig. 1
(B) An arteriovenous wire loop is formed from a femoral venous approach. As the delivery sheath is advanced across the defect the wire is prolapsed from the aorta into the LV so that the delivery sheath is placed in the apex of the ventricle.
(C) The device is loaded and advanced through the sheath and deployed in the defect under TEE guidance. The platinum marker on the LV disk should be pointing toward the apex of the LV. A left ventricular angiogram confirms appropriate device placement.
(D) The device is released from the delivery system. An aortogram is performed to assess for aortic insufficiency.