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SEVERE AORTIC INSUFFICIENCY DUE TO A PERIMEMBRANOUS VENTRICULAR SEPTAL DEFECT
2204 JACC March 21, 2017 Volume 69, Issue 11
FIT Clinical Decision Making SEVERE AORTIC INSUFFICIENCY DUE TO A PERIMEMBRANOUS VENTRICULAR SEPTAL DEFECT Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: FIT Clinical Decision‐Making: Non-Invasive Imaging and Valvular Heart Disease Abstract Category: Valvular Heart Disease Presentation Number: 1129-429 Authors: Kinan Carlos El Tallawi, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
Background: Patients with perimembranous ventricular septal defect (VSD) during childhood are at high risk for development of aortic insufficiency later in life.
Case: A 40-year-old male presented with shortness of breath. His medical history included a VSD for which he had incomplete follow-up as a child. Physical exam was significant for systolic and diastolic murmurs. TTE revealed severe aortic insufficiency (AI) and a VSD. TEE to better elucidate AI mechanism showed possible aortic cusp prolapse through a 6 mm membranous VSD. Decision‐Making: Being symptomatic with severe AI, the patient was scheduled for operative intervention. However, it was not entirely clear if his relatively narrow VSD was the initial underlying pathology and whether it should be surgically closed. This had significance due to the risk of injury to the conduction system during defect suturing. The patient underwent aortic valve replacement. Intraoperative inspection revealed a wider perimembranous VSD of 15 mm, which was successfully sutured. Pathologic valve inspection reported one leaflet with an aneurysmal configuration which, together with the wide septal defect, supported the mechanism of leaflet prolapse.
Conclusions: This case highlights the importance of careful follow-up in patients with perimembranous VSD due to the risk of developing significant AI. It also sheds light on the underestimation of VSD sizing using color Doppler which could be a result of the reduction in left-toright shunt by the prolapsing cusp.
FIT Clinical Decision Making SEVERE AORTIC INSUFFICIENCY DUE TO A PERIMEMBRANOUS VENTRICULAR SEPTAL DEFECT Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: FIT Clinical Decision‐Making: Non-Invasive Imaging and Valvular Heart Disease Abstract Category: Valvular Heart Disease Presentation Number: 1129-429 Authors: Kinan Carlos El Tallawi, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
Background: Patients with perimembranous ventricular septal defect (VSD) during childhood are at high risk for development of aortic insufficiency later in life.
Case: A 40-year-old male presented with shortness of breath. His medical history included a VSD for which he had incomplete follow-up as a child. Physical exam was significant for systolic and diastolic murmurs. TTE revealed severe aortic insufficiency (AI) and a VSD. TEE to better elucidate AI mechanism showed possible aortic cusp prolapse through a 6 mm membranous VSD. Decision‐Making: Being symptomatic with severe AI, the patient was scheduled for operative intervention. However, it was not entirely clear if his relatively narrow VSD was the initial underlying pathology and whether it should be surgically closed. This had significance due to the risk of injury to the conduction system during defect suturing. The patient underwent aortic valve replacement. Intraoperative inspection revealed a wider perimembranous VSD of 15 mm, which was successfully sutured. Pathologic valve inspection reported one leaflet with an aneurysmal configuration which, together with the wide septal defect, supported the mechanism of leaflet prolapse.
Conclusions: This case highlights the importance of careful follow-up in patients with perimembranous VSD due to the risk of developing significant AI. It also sheds light on the underestimation of VSD sizing using color Doppler which could be a result of the reduction in left-toright shunt by the prolapsing cusp.