Percutaneous device closure of iatrogenic right ventricular perforation during attempted ventricular septal defect closure: a case report

Cardiac perforation is a rare but life-threatening complication of transcatheter cardiac procedures, particularly in children where tissue fragility increases risk. We present a rare case of iatrogenic right ventricular perforation during transcatheter ventricular septal defect closure in a pediatric patient. During the procedure, inadvertent withdrawal of the Terumo guidewire caused perforation of the right ventricular apex, leading to cardiac tamponade and cardiopulmonary arrest. Emergency pericardiocentesis with pigtail catheter placement and autotransfusion restored hemodynamic stability, after which transcatheter repair was selected over surgical intervention due to the patient's critical condition. An 8 mm Shanghai Shape Memory Alloy occluder was successfully deployed to seal the perforation, resulting in complete hemostasis and a stable recovery. This case highlights that transcatheter device closure can serve as a life-saving alternative to emergent surgery for iatrogenic cardiac perforations in children, offering a minimally invasive solution in high-risk scenarios.