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LETTER TO THE EDITOR |
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Year : 2016 | Volume
: 9
| Issue : 4 | Page : 548-549 |
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Coexistent perimembranous ventricular septal defect, subaortic membrane, and moderate rheumatic aortic ınsufficiency in a middle-aged woman
Ercan Aydin1, Altug Osken2, Ibrahim Kocayigit1, Selcuk Yaylaci3, Salih Sahinkus1, Yusuf Can1, Tugba Kemaloglu Oz2, Huseyin Gunduz1
1 Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey 2 Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey 3 Department of Internal Medicine, Rize Findikli Guatr Research Center, Fındıklı/Rize, Turkey
Date of Web Publication | 12-Jul-2016 |
Correspondence Address: Altug Osken Dr. Siyami Ersek Thorasic and Cardiovascular Surgery Center, Cardiology Clinic, Tibbiye cad 13, Haydarpasa, Kadikoy, Istanbul 34846 Turkey
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.186050
How to cite this article: Aydin E, Osken A, Kocayigit I, Yaylaci S, Sahinkus S, Can Y, Oz TK, Gunduz H. Coexistent perimembranous ventricular septal defect, subaortic membrane, and moderate rheumatic aortic ınsufficiency in a middle-aged woman. Med J DY Patil Univ 2016;9:548-9 |
How to cite this URL: Aydin E, Osken A, Kocayigit I, Yaylaci S, Sahinkus S, Can Y, Oz TK, Gunduz H. Coexistent perimembranous ventricular septal defect, subaortic membrane, and moderate rheumatic aortic ınsufficiency in a middle-aged woman. Med J DY Patil Univ [serial online] 2016 [cited 2024 Mar 28];9:548-9. Available from: https://journals.lww.com/mjdy/pages/default.aspx/text.asp?2016/9/4/548/186050 |
Sir,
Rheumatic aortic insufficiency (AI) is an autoimmune valvular heart disease (VHD) which usually develops years to decades after a rheumatic fever (RF).[1] Ventricular septal defect (VSD) is a common congenital heart defect in both children and adults.[2] Coexistent congenital VSD, subaortic membrane, and acquired rheumatic AI in an adult is a very rare combination that has not been reported previously. We discuss an unusual presentation of a middle-aged woman with coexistent perimembranous VSD, subaortic membrane, and moderate rheumatic AI presenting with progressive exertional dyspnea and palpitations.
An 18-year-old girl was referred for evaluation of worsening exertional breathlessness and palpitations. She has no history of RF. On physical examination, a loud second heart sound and a grade 4/6 pansystolic precordial murmur were noted, lungs are clear to auscultation. An electrocardiogram showed sinus rhythm. Two-dimensional echocardiography demonstrated a calcified fibrotic aortic valve with the subaortic membrane, moderate AI, fibrotic mitral valve, and mild mitral insufficiency without accompanying mitral stenosis. These findings strongly suggest the possibility of rheumatic VHDs. Echocardiography also revealed a 4 mm VSD located in the perimembranous region. Qp/Qs ratio was calculated 1.1. Although definitive evidence of prior streptococcal infection was lacking, a diagnosis of probable rheumatic aortic and mitral valve disease with VSD was accepted on the basis of the echocardiographic appearance of the valves. She was discharged with 3 weekly injections of 1,200,000 units of benzathine penicillin.
A VSD is an abnormal opening between the right ventricle and the left ventricle. The membranous septum is small and is located at the base of the heart between the inlet and outlet components of the muscular septum and below the right, and noncoronary cusps of the aortic valve. About 80% of VSD's are membranous (or perimembranous) VSD.[2] Rheumatic heart disease is the most serious complication of RF. VSD may coexist with congenital valve diseases,[3] but the association of rheumatic AI with VSD and the subaortic membrane has not been reported previously. In the presence of important coexisting cardiac anomalies as in our case, symptoms are expected to occur even earlier. This report highlights the need for careful evaluation of patients with congenital heart disease for a coexisting rheumatic condition, and attention to the possibility of a rheumatic process affecting them during subsequent follow-up.
Patients with congenital heart disease must be evaluated carefully for a coexisting rheumatic condition; a rheumatic process may affect and cause worsening during the follow-up the patient.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | | |
1. | Oliver JM, González A, Gallego P, Sánchez-Recalde A, Benito F, Mesa JM. Discrete subaortic stenosis in adults: Increased prevalence and slow rate of progression of the obstruction and aortic regurgitation. J Am Coll Cardiol 2001;38:835-42. |
2. | Penny DJ, Vick GW 3 rd. Ventricular septal defect. Lancet 2011;377:1103-12. |
3. | Bove EL, Minich LL, Pridjian AK, Lupinetti FM, Snider AR, Dick M 2 nd, et al. The management of severe subaortic stenosis, ventricular septal defect, and aortic arch obstruction in the neonate. J Thorac Cardiovasc Surg 1993;105:289-95. |
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