A 2-week-old, 3.5 kg child was transferred from a distant hospital (300 miles away) on congestive heart failure. Suspected diagnosis was ventricular septal defect (VSD), atrial septal defect (ASD), and pulmonary hypertension (PHT). On arrival at the authors’ NICU, the patient was stabilized with diuretics and vasodilators and eventually intubated. Echo showed an apical VSD and ASD. Cath lab exploration confirmed the diagnosis, ruling out PHT and mitral pathology.

Discussion about the best approach was held. Pulmonary artery banding is always a straightforward palliative option. Neither peripheral nor perventricular hybrid VSD closure sounded appropriate. Surgical VSD closure was regarded as the best choice to fix the defect.