A 58-year-old female was evaluated for shortness of breath on moderate exertion. Cardiac history is that of a known small asymptomatic PM-VSD diagnosed two decades earlier. Physical examination was notable for a harsh ejection systolic murmur (grade III/VI) at the left sternal border. Electrocardiogram (ECG) revealed RVH. TTE revealed a large (14 mm) PM-VSD with left to right shunt. RVH and muscular septation of the RV causing mid-ventricular obstruction with a peak gradient of -75-80 mm Hg was noted. CMR showed prominent RVOT muscle bundles causing flow turbulence with significant obliteration in systole (area -0.6 cm2) ( and , ). Cardiac catheterization confirmed the presence of DCRV, with an 85 mm Hg pressure gradient between the proximal and distal chambers. A decision was made to proceed with surgical repair; however, the patient declined further intervention.
An asymptomatic 33-year-old female with a known small PM-VSD was followed up in our clinic. Past history was remarkable for a surgical closure of patent ductus arteriosus early in life. Physical examination was notable for a pansystolic murmur (grade II/VI) at the left sternal border. ECG was normal. TTE revealed a small (-3-4 mm) PM-VSD with left to right shunt and RV muscular septation causing no significant obstruction. CMR showed prominent RVOT muscle bundles causing no significant flow turbulence ( and , ). No action was taken due to the benign nature of DCRV in this patient.