Iatrogenic ventricular septal defect during right ventricular assist device insertion in congenitally corrected transposition of the great arteries

This case report describes the management of a large iatrogenic ventricular septal defect (VSD) created by the coring device during systemic ventricular assist device (right ventricular assist device [RVAD]) insertion in a 16-year-old patient with congenitally corrected transposition of the great arteries. The VSD was closed by a bovine pericardial patch and the ventriculotomy was extended laterally to relocate the VAD sewing ring. After RVAD implantation, the patient initially remained cyanotic, potentially due to a tiny VSD patch leak with right-to-left shunting. Hypoxia was successfully corrected by rescue nitric oxide infusion and the patient was bridged to transplant after 91 days.