Transcatheter Closure of RSOV More Than One Way—A Case Series

Ruptured sinus of Valsalva aneurysms are rare congenital anomalies that can lead to significant hemodynamic compromise, thus requiring urgent intervention. This case series describes three successful transcatheter closures of large ruptured sinus of Valsalva defects (>10 mm) using dual-device deployment techniques when single devices failed due to prolapse or residual shunts. Cases involved ruptured sinus of Valsalva from the noncoronary cusp to the right atrium and the right coronary cusp to the right ventricular outflow tract, with complete occlusion achieved using combinations of Cocoon duct occluders and muscular ventricular septal defect occluders, demonstrating the feasibility and safety of percutaneous approaches in suitable anatomies.