A rare case of subarterial ventricular septum defect associated with other cardiac pathologies in an adult

in Echo Research and Practice
View More View Less
  • 1 Departments of Cardiothoracic Surgery, Cardiology, Anesthesia and Intensive Care, Aristotle University Medical School, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece

Correspondence should be addressed to P Tossios Email: ptossios@hotmail.com
Open access

A 67-year-old woman developed exertional dyspnea. Echocardiography revealed a subarterial ventricular septum defect (VSD), hypertrophy of the basal septum leading to subvalvular obstruction, severe aortic regurgitation, and an ascending aorta aneurysm (Fig. 1, Videos 1 and 2). Surgical repair consisted of transaortic VSD patch closure, septal myectomy, and separate replacement of the aortic valve and the ascending aorta (Fig. 2).

Figure 1
Figure 1

Transesophageal echocardiogram (TEE). Two-dimensional TEE without (A) and with color (B) showing subarterial VSD (red arrow) and hypertrophy of the basal septum (white arrow) below the VSD. The defect was ∼5 mm in size and hemodynamically benign as the pulmonary to systematic blood flow ratio (Qp/Qs) was calculated from cardiac catheterization data to be 1.6:1. The ascending aorta was 58 mm in diameter and severe aortic valve regurgitation was present. Ao, ascending aorta; LA, left atrium; LV, left ventricle; VSD, ventricular septum defect.

Citation: Echo Research and Practice 1, 1; 10.1530/ERP-14-0022

Transesophageal echocardiogram (TEE). Two-dimensional TEE without color, showing subarterial VSD and hypertrophy of the basal septum below the VSD. View Video 1 at http://movie-usa.glencoesoftware.com/video/10.1530/ERP-14-0022/video-1.

Download Video 1

Transesophageal echocardiogram (TEE). Two-dimensional TEE with color, showing subarterial VSD and hypertrophy of the basal septum below the VSD. View Video 2 at http://movie-usa.glencoesoftware.com/video/10.1530/ERP-14-0022/video-2.

Download Video 2

Figure 2
Figure 2

(A) At the time of operation, the VSD (white arrow) was larger (12×15 mm) than anticipated and was limited upstream by the semilunar valves, but was otherwise surrounded by muscle. The tricuspid aortic valve was excised due to severe calcification of the right coronary cusp. The defect lies beneath the right coronary cusp in the outlet septum. The ostium of the right coronary artery is indicated by the black arrow. (B) Transaortic visualization of the septal subaortic bulge (white arrow), narrowing the outflow tract before surgical septal myectomy (Morrow procedure). NCS, non-coronary sinus.

Citation: Echo Research and Practice 1, 1; 10.1530/ERP-14-0022

Declaration of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

 

    British Society of Echocardiography

Sept 2018 onwards Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 715 61 6
PDF Downloads 269 87 1
  • View in gallery

    Transesophageal echocardiogram (TEE). Two-dimensional TEE without (A) and with color (B) showing subarterial VSD (red arrow) and hypertrophy of the basal septum (white arrow) below the VSD. The defect was ∼5 mm in size and hemodynamically benign as the pulmonary to systematic blood flow ratio (Qp/Qs) was calculated from cardiac catheterization data to be 1.6:1. The ascending aorta was 58 mm in diameter and severe aortic valve regurgitation was present. Ao, ascending aorta; LA, left atrium; LV, left ventricle; VSD, ventricular septum defect.

  • View in gallery

    (A) At the time of operation, the VSD (white arrow) was larger (12×15 mm) than anticipated and was limited upstream by the semilunar valves, but was otherwise surrounded by muscle. The tricuspid aortic valve was excised due to severe calcification of the right coronary cusp. The defect lies beneath the right coronary cusp in the outlet septum. The ostium of the right coronary artery is indicated by the black arrow. (B) Transaortic visualization of the septal subaortic bulge (white arrow), narrowing the outflow tract before surgical septal myectomy (Morrow procedure). NCS, non-coronary sinus.