Key Points · Perventricular device closure of peri-membranous ventricular septal defects is safe and effective when compared to conventional surgery and transcatheter device closure. · Intraprocedural transesophageal echocardiography can effectively guide perventricular device closure of peri-membranous ventricular septal defects and improve safety and success rate. · Hybrid approach improves the outcomes in select patients with congenital heart diseases and complex anatomical defects.

ABSTRACT Post infarction ventricular septal rupture (PIVSR) is an infrequent but potentially fatal complication of acute myocardial infarction. • The 30-day mortality rate with the transcatheter approach when performed in the acute phase (less than two weeks) was 25.3% compared to 50% when surgery is performed in the acute phase (within three weeks). • There is no correlation between defect size and mortality. • NYHA class IV and time to VSD closure are risk predictors for transcatheter closure for a 30-day mortality rate of 31.5%.

Key Points : • Interventional therapies directed at fenestration closure in the Fontan patient must rely on good hemodynamic data • The Large Optimus-CVSTM stent is an additional armamentarium for fenestration closure however, longer term follow up is needed • Multi institutional studies defining the long-term benefits of fenestration closure and outlining fenestration management guidelines may help improve the long-term morbidity and mortality in this group of patients.