Percutaneous Perventricular Device Closure of Ventricular Septal Defect: From Incision to Pinhole Changping Gan, MD, Ling Peng, MD, Zhonglei Liang, MD,

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Percutaneous Perventricular Device Closure of Ventricular Septal Defect: From Incision to Pinhole Changping Gan, MD, Ling Peng, MD, Zhonglei Liang, MD, Haibo Song, MD, Jiahuang Yang, MD, Weiqiang Ruan, MD, Shuhua Luo, MD, Ke Lin, MD The Annals of Thoracic Surgery Volume 103, Issue 1, Pages 172-177 (January 2017) DOI: 10.1016/j.athoracsur.2016.09.061 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 A delivery sheath was advanced through the guidewire into the heart through the chest wall at the third intercostal space. (caud = caudal; ceph = cephalic; L = left; R = right.) The Annals of Thoracic Surgery 2017 103, 172-177DOI: (10.1016/j.athoracsur.2016.09.061) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) After deployment of the ventricular septal defect device (white arrow), the delivery sheath (dashed line arrow) was kept inside the right ventricle (RV). Another concentric device was loaded into the delivery sheath and sent into the RV. (B) The left disc (dashed line arrow) of this device was deployed in the right ventricular outflow tract, and (C) it was then pulled back to lie tightly against the right ventricular free wall. (D) This device (dashed line arrow) would be completely deployed by leaving the right disc outside the heart. (AO = aorta; AV = aortic valve; LV = left ventricle; RA = right atrium.) The Annals of Thoracic Surgery 2017 103, 172-177DOI: (10.1016/j.athoracsur.2016.09.061) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The puncture site left on the skin after percutaneous perventricular device closure. (caud = caudal; ceph = cephalic; L = left; R = right.) The Annals of Thoracic Surgery 2017 103, 172-177DOI: (10.1016/j.athoracsur.2016.09.061) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 A tailored probe was secured on a patient’s chest to ensure continuous monitoring of pericardial effusion in the same view. The Annals of Thoracic Surgery 2017 103, 172-177DOI: (10.1016/j.athoracsur.2016.09.061) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions