Figures legends
Figure 1 . Two-dimensional transesophageal echocardiography (TEE) image showing a large ventricular septal rupture 28 mm in diameter (bracket) located at the infero-posterior septum.
RV: right ventricle; LV: left ventricle; LA: left atrium
Figure 2 . Two-dimensional transthoracic echocardiography (TTE) apical four-chamber (A,B ) and short-axis color Doppler (C,D ) views showing post-surgical ventricular residual rupture 18,6 mm in diameter (yellow arrow) with left-to-right shunt (white arrow).
RV: right ventricle; LV: left ventricle
Figure 3 . Fluoro-angiographic procedural steps. A : An arteriovenous rail established using a retrograde arterial approach (left femoral artery) with a 5F multipurpose catheter and a Terumo wire that was advanced through the septal rupture into the inferior vena cava, where it was snared via the right femoral vein; B-D : the 24 mm PIVSR occluder (black arrows) delivered through the dedicated delivery system (arrowhead) across the septal rupture; the welded ball of the device is secured to the dedicated delivery system (white arrow);E : zoom fluoro image showing the device deployment: the welded ball (white long arrow) is no more attached to the dedicated Flex Pusher II delivery system; two radiopaque gold markers are clearly seen on the distal disc. F : final LV angiogram showing a stable device position with mild residual left-to-right shunt.
Figure 4 . Two-dimensional transthoracic echocardiography (TTE) at 6-month follow-up. Apical four-chamber (A ) and short-axis color Doppler (B-C ) views showing the 24-mm PIVSD occluder in situ (yellow arrow) with trivial residual left-to-right shunt.
RV: right ventricle; LV: left ventricle.