Step-by-step tweetorial on percutaneous post-infarct VSD closure. Late presenting inferior MI. Cardiac CT can be very helpful in planning the approach and in noting nearby structures. Here, the defect is quite basal - semilunar valves can disrupted.

Here are some important interventional cardiology algorithms I've compiled over the past couple of years. The good IC/CTO operator always knows what the next step is. Major credit to @esbrilakis for many of these algorithms. Must think systematically about every PCI. 1/ Very nice algorithm on tough to wire vessels. Important techniques to know: Use of SuperCross (only use 120/they tend to straighten out), Hairpin wiring technique, deflection balloon, and probably most importantly, appropriate wire shape. 2/