The position of occluder discs and potential impingement of
the device on adjacent cardiac structures were evaluated. Colour
Doppler assessment of residual shunting, aortic regurgitation, and
atrioventricular valve function were also assessed (Figure 6). The asymmetric
device was implanted by using a gentle rotation to position the
platinum marker of the distal disc downwards and ensure that the flat
part of the disc was not directly under the aortic valve. The waist and
the right disc of the occluding device were deployed while maintaining
moderate traction on the delivery cable (Figure 7). The occluder device
was released only if the echocardiogram demonstrated a correct position
with no evidence of significant residual shunting, cardiac valve
malfunction, or outflow tract obstruction. The sheath and delivery
cable were then withdrawn with the suture tied firmly. All patients
underwent echocardiographic examination before discharge from the
hospital and at follow-up visits.