A 16 - year- old female was admitted to our hospital with tachycardia. Transthoracic echocardiography revealed a malignment type perimembraneous ventricular septal defect with left-to-right shunt, a discrete membrane forming a dynamic subaortic stenosis with a pressure gradient of 50 mm Hg in the left ventricular outflow tract and an asymmetrically hypertrophied interventricular septum. Cardiac catheterization pointed out no additional pathology.

She was operated under endotracheal general anesthesia and in supine position. During surgical period discrete membrane was resected following aortotomy. After right ventriculotomy an aneurysm was revealed on the interventricular perimembranous septum(Figure 1).

Figure 1

Figure 1

During operation, mitral leaflets showed neither organic lesions nor prolapse. Cribriform ventricular septal defect pores were present on the aneurysm. This aneurysm was repaired by wrapping the tissue over itself (Figure 2).

Figure 2

Figure 2

Then, the defect of patent foramen ovale was repaired primarily. Incisions of right atriotomy, ventriculotomy and aortotomy were closed. The post-operative course was uneventful. Postoperative echocardiographic data confirmed complete correction of the lesions.

Comments

The ventricular septal defect (VSD) may close spontaneously in the first few years of life. The closure occurs by muscle's growth of the borders of the defect or by the appearance of an aneurysm of ventricular septum composed mostly by tricuspid tissue(₁). VSD diminish in size by “aneurysmal transformation”(₂). It was recently shown that the appearance of aneurysmal transformation may be associated with subaortic ridges(₂).

The morphology of the aneurysmal transformation in perimembranous ventricular septal defect can be characterized by echocardiograms(₃). Two-dimensional echocardiography is the best method to determine the mechanisms that take part in the aneurysm formation(₁).

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Doç. Dr. Ufuk YETKIN, 1379 Sok. No: 9,Burç Apt. D: 13 - 35220, Alsancak – IZMIR / TURKEY Tel: +90 505 3124906 , Fax: +90 232 2434848 e-mail: ufuk_yetkin@yahoo.fr