A cardiac catheterization was performed, and pressure records were as follows: left ventricle, 102/0 mm Hg; right ventricle, 35/0 mm Hg; pulmonary artery, 30/16/23 mm Hg; and right atrium, 30/5/19 mm Hg. The left-to-right shunt was 3.7/1 by oximetry. A left ventricular angiography showed a 12-mm muscular VSD (Fig 1
). We decided to close the defect with a 12-mm Amplatzer muscular VSD occluder. This device is made from Nitinol1
wire mesh that has been shaped by heat treatment into a central stent with two retention discs. It is very similar to the atrial septal defect device. To place a 9F-delivery sheath within the left ventricle, an arteriovenous loop was first introduced from the arterial side with capture of 0.020-inch guidewire in the pulmonary artery. During placement of the occluder across the defect, the device slipped into the right ventricle and was then retrieved within the delivery sheath. We decided thus to use a 15-mm Amplatzer septal occluder, which was similarly delivered (Fig 2
). After release, control left ventricular angiography showed good position of the device and minimal residual shunt. On the next day, he presented with pallor and significant hematuria. Blood tests revealed intravascular hemolysis; his hemoglobin level fell from 14 to 8.5 g/dL, and haptoglobin level was 0.08 g/L. He did not require any blood transfusion, and hemolysis stopped spontaneously after a few days. Six months later, repeat echocardiography showed a tiny residual shunt and persistent tricuspid insufficiency. This patient is waiting for further surgery to repair the tricuspid valve.