Key Points
·     Perventricular device closure of peri-membranous ventricular septal defects is safe and effective when compared to conventional surgery and transcatheter device closure. ·     Intraprocedural transesophageal echocardiography can effectively guide perventricular device closure of peri-membranous ventricular septal defects and improve safety and success rate. ·     Hybrid approach improves the outcomes in select patients with congenital heart diseases and complex anatomical defects.