Challenging transcatheter closure of a perimembranous ventricular septal defect using the Amplatzer Trevisio delivery cable

We report a challenging perimembranous ventricular septal defect (pmVSD) with two right ventricular openings and septal aneurysm for which we successfully performed a transcatheter closure using the new Amplazter Trevisio delivery cable, our first experience with this device. During the procedure there was some difficulty establishing a straight arteriovenous (AV) loop, crossing the desired opening, and placing the Amplatzer Ductal Occluder (ADO I) 10-8 device in good alignment to close the VSD shunt without damaging the adjacent valves. We report the techniques used to overcome these obstacles in this case and highlight how the newly added flexible part of the Trevisio facilitated the orientation of the device, assessment of adjacent valve regurgitation, and the stability before release. •A challenging case of transcatheter closure of aneurysmal type perimembranous ventricular septal defect with two right ventricular exits•A straight course of the AV-loop is crucial for a successful procedure and to reduce the risk of tricuspid valve injury.•A new version of delivery cable could help to improve the deployment process in terms of less tension and position shift.