Trans-catheter closure of large peri-membranous ventricular septal defect with multiple exits using two occluder devices

Aneurysmal peri-membranous ventricular septal defects (PM-VSD) may show multiple right ventricular exits separated by tricuspid chordae or trabeculations. Transcatheter PM-VSD closure is increasingly performed as a surgical alternative. An 8-year-old girl with a large PM-VSD, with moderate pulmonary hypertension, presented with dyspnea and recurrent respiratory infections. The defect measured 12 mm with two exits. Closure was successfully achieved using two devices through an antegrade approach with two arteriovenous loops. There was no residual shunt, aortic regurgitation, or conduction block on follow-up. Transcatheter closure of PM-VSDs with multiple exits using two devices is feasible and safe in selected patients.