Ventricular Septal Defect Occluder Device causing Left Ventricular Outflow Tract Obstruction

The American Heart Association recommends percutaneous transcatheter device closure in patients with muscular or perimembranous ventricular septal defects (VSDs) who have suitable anatomy and a hemodynamically significant left to right shunt with left heart volume overload. Device related complications may include vascular injury, infection, conduction disturbances, residual shunt, hemolysis, and device embolization. Left ventricular outflow tract (LVOT) obstruction after percutaneous VSD closure is a known but less common complication, occurring when the occluder device or surrounding tissue narrows the LVOT. Treatment options for significant LVOT obstruction include percutaneous strategies, such as device repositioning or balloon dilation, as well as surgical revision. Surgical strategy for occluder-associated LVOT obstruction is to remove the occluder and close the VSD. We describe here a novel technique to relieve the LVOT obstruction when removal of the occluder device was not possible.