LAUSR

The procedure was performed under general anaesthesia with transoesophageal echocardiographic (TEE) guidance. A right femoral artery access was obtained, gaining access to the LV. Unfractionated heparin was administered to maintain the activated clotting time above 250 s. Using the fluoroscopic projection identified by CT, the free wall breach was easily crossed with a 0.03500 StorQ wire (Cordis, Dublin, Ohio, USA) and a 6-Fr Multipurpose catheter (Cordis) which was then exchanged for a 110 cm 8-Fr Flexor Introducer (Cook Medical, Bloomington, Indiana, USA) (Fig. 1c, Video 2, http://links.lww. com/JCM/A324). Based on CT measurement of the breach (5 9 mm), which was confirmed by TEE, a 10-mm Amplatzer Muscular Ventricular Septal Defect (VSD) Occluder (Abbott, Santa Clara, California, USA) was then implanted across the defect, to achieve 1 mm oversize relative to its maximum diameter. Both left ventriculography and TEE revealed the complete exclusion of the LVPA (Fig. 1, Video 3, http://links.lww.com/ JCM/A325, Video 4, http://links.lww.com/JCM/A326).