Tough Calls: Case 11
Ventricular Septal Defect (VSD)
Imagine how you would work through each case. What equipment would you select and what would you do first? After having a go at it, see what our panel would do in the same situation. This exercise highlights the many possible approaches to a difficult problem. By seeing what others would do after thinking it through yourself, you will gain an understanding of the spectrum of approaches to a problem.
36 year old male, with congenital corrected transposition and a systemic AV valve replacement was diagnosed with a significant VSD. A 33mm bileaflet metallic valve was implanted, and a permeant pacemaker was required due to a second degree 2 to 1 heart block. It was recommended that he have a VSD closure prior to having a transvenous pacemaker for stroke prevention. Additionally, the VSD was aborted at another hospital due to the elongated structure which resulted in a inadequate fit of the device.
How would you proceed?