Percutaneous Device Closure of Perimembranous Ventricular Septal Defect (VSD) in Congenitally Corrected Transposition...

Congenitally corrected transposition of great arteries (cc-TGA) is often accompanied by associated lesions with a wide spectrum of presentations. Traditionally, ventricular septal defects (VSDs) in such patients have been managed surgically with either physiologic repair or, more recently, there is a paradigm shift towards anatomical repair, such as the double switch operation. Percutaneous VSD device closure in cc-TGA physiology is extremely rare, with only isolated case reports in the literature. The present case report highlights a 15-year-old female, previously diagnosed with cc-TGA with moderate right atrio-ventricular valve regurgitation (AVVR), who presented to us with a history of shortness of breath for the last 1 year. The presence of perimembranous VSD with VSD jet directed towards the right atrioventricular (AV) valve, leading to moderate right AVVR, was identified during detailed evaluation. Cardiac catheterization was undertaken for better visualization and hemodynamic assessment, which revealed sub-systemic morphological left ventricle pressures and a device suitable VSD anatomy. Considering physiologic repair, VSD device closure was done in the same setting. The procedure was adapted to account for the altered cardiac anatomy by adjusting the fluoroscopic angles and wire-torquing manoeuvres. A KONAR-Multifunctional Occluder device (MFO) 10 × 8 mm was successfully deployed via an antegrade approach without complications utilizing hemodynamic and echocardiographic guidance, with good follow-up outcomes. Our case underscores the unique challenges of this complex cardiac anatomy and suggests technical modifications for successful percutaneous VSD closure. In conclusion, VSD device closure in atypical scenarios like cc-TGA can be a safe and feasible option for physiologic repair in selected cases.