Patients with a significant left-to-right shunt at ventricular level may become inoperable at an early age due to irreversible pulmonary vascular disease. On the other hand, even suprasystemic pulmonary hypertension due to mitral stenosis remains treatable. We report a 24-year-old patient with large ventricular septal defect, severe mitral stenosis and cyanosis who improved after surgical correction of both the lesions. This emphasises the importance of additional post-capillary pulmonary hypertension in Eisenmenger syndrome.

Transcatheter closure of a multi-hole perimembranous ventricular septal defect with an aneurysm is challenging. Specific ventricular septal defect closure devices have been developed, but some occluders are reportedly used in an off-label manner. This report describes a child who had a multi-hole perimembranous ventricular septal defect with an aneurysm and underwent successful transcatheter closure using two different occluders: the Occlutech Duct Occluder (Occlutech, Helsingborg, Sweden) and the Amplatzer Duct Occluder II (St. Jude Medical, Saint Paul, Minnesota, United States of America). Transcatheter closure of a multi-hole perimembranous ventricular septal defect with an aneurysm using these two different devices can be performed safely by an experienced interventionist in selected patients.

This is the first attempt to use a temporary occluder to close a giant perimembranous ventricular septal defect (32 mm), which obtains clinical evidence of good haemodynamics in patients with severe pulmonary hypertension. This may provide an alternative assessment to guide cardiac surgeons in determining a definitive treatment.

Left aortic arch with right descending aorta is a rare congenital anomaly. We describe the clinical presentation of this unusual anomaly associated with cardiorespiratory compromise from severe aortic obstruction and left main bronchus compression. The anatomical peculiarities, embryological basis, and surgical solutions are presented.