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Hyper-dominant left anterior descending artery (LAD) is a rare coronary anomaly where LAD continues as a posterior descending artery. It is a rare coronary anomaly and there are only 19 cases reported so far in 17 case reports in the literature. Its involvement during acute coronary syndrome can be fatal as it leads to ischemia/infarction of a larger area of left and/or right ventricular myocardium. Its early recognition and management is essential with a high index of clinical suspicion.

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Cases of uncorrected adult tetralogy of Fallot are rare and mostly manifest secondary to complications. A 30-year-old man presented with progressive breathlessness and severe chest discomfort. Echocardiography revealed tetralogy of Fallot with a left ventricular apical clot and DeBakey type I dissection of the aorta. The patient underwent successful surgical correction. The combination of preoperative complications in the setting of uncorrected tetralogy of Fallot, such as a left ventricular clot and DeBakey type I dissection of the aorta, is very rare.

Aims & Objective: Transcatheter ventricular septal defect (VSD) device closure is usually performed using the antegrade approach [1-3]. A few case series of a retrograde technique using the Amplatzer duct occluder (ADO) II device have been reported [4, 5]. We aimed to assess the feasibility and safety of a retrograde closure technique using an ADO I like device, which is used for the closure of patent ductus arteriosus (PDA). Methods: Between June 2015 and January 2018, eight consecutive, consenting cases with congenital perimembranous VSDs underwent trans-aortic device closure using an ADO I like device in a single tertiary care center. Results: The median age was 17.1 years (5-32, SD 17.125 years) with 3 males and 5 females. Mean defect size was 6.6 mm (4.5-8.6 mm, SD 6.6125), with a median aortic rim of 3.4 mm (2-5, SD 3.4125). Median Qp/Qs and right ventricular systolic pressure was 1.8 (1.6-2.1, SD 1.825) and 41.3 mm Hg (33-50, SD 41.25) respectively. Median fluoroscopy and procedure times were 13.3 (10.6-15.7, SD 13.275) and 23.5 (18.2-27.2, SD 22.722) minutes respectively. The defects were successfully closed with no residual shunt in all 8 patients (100%). There was no