Device selection
Final operation plan of PmVSD was chosen according to the TEE results of
the patient after anesthesia in the operating room (Fig. 3A). The size,
location, morphology, and surrounding tissue of PmVSD were
comprehensively evaluated. For PmVSD with AMS, the diameter, number and
direction of the defect in the
AMS and the distance between the defects were seriously analyzed.
Simultaneously, the left ventricular side diameter of AMS was carefully
measured. A proper concentric occluder device size was chosen according
to the diameter of the VSD by TEE measure. Usually, the waist sizes of
devices were 0.5-1.5 mm larger than the VSD maximum diameters. For the
patients who had multistream (more than or equal to 2) PmVSDs in the
AMS, the occluder was selected according to the specific circumstances
such as the multistream maximum distance and the left ventricular side
diameter of AMS.