Device closure
For defects with multiple right ventricular openings, and a single left
ventricular opening, the Amplatzer delivery system should be positioned
through the largest right ventricular opening to avoid compression of
the device. For those defects with so-called “wind sock type”
morphology, with a large left ventricular orifice and smaller right
ventricular sites of exit, the device should be placed within the wind
sock to avoid interference with the conduction system and/or aortic
valve. Since patients with previous banding of the pulmonary trunk may
not exhibit shunting across the multiple defects, it is crucial to
deband prior to any attempted hybrid closure. It is always desirable to
cross the largest defect first and subsequently cross the smaller
defects.21-28,51-55
Swiss-cheese defects