Zero contrast technique in doubly committed subarterial ventricular septal defect closure in patient with body weight less than 10 kg: a case report.

Introduction: The complex anatomy of DCSA VSD, its proximity to valvular and conduction tissues, and concerns about radiation and contrast make transcatheter closure particularly challenging in pediatric patients. While zero-fluoroscopy closure was not achievable in this case, we successfully performed zero-contrast transcatheter closure in a baby weighing less than 10 kg. This report highlights the feasibility and early outcomes of this approach at our institution. Case illustration: An 18-month-old, 9 kg boy with a history of feeding difficulties, failure to thrive, and breathlessness since 14 days of age underwent transcatheter closure of a doubly committed subarterial (DCSA) ventricular septal defect (VSD). Transthoracic echocardiography revealed a 4-5 mm left-to-right shunting VSD with preserved ventricular function. Initial attempts to cross the VSD under zero-fluoroscopy guidance using various catheters were unsuccessful, necessitating fluoroscopic assistance without contrast. A Konar-MF VSD occluder (7/5 mm) was successfully deployed retrogradely, achieving complete defect closure with no residual shunt or valve dysfunction. Post-procedure, the patient remained asymptomatic, with excellent device positioning and no complications noted at follow-up. Conclusion: This case demonstrates the feasibility of zero-contrast percutaneous DCSA-VSD closure in selected patients weighing less than 10 kg. Further studies are needed to validate its safety and long-term outcomes.