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