Table of Contents  
LETTER TO THE EDITOR
Year : 2016  |  Volume : 9  |  Issue : 4  |  Page : 548-549  

Coexistent perimembranous ventricular septal defect, subaortic membrane, and moderate rheumatic aortic ınsufficiency in a middle-aged woman


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 Publication12-Jul-2016

Correspondence Address:
Altug Osken
Dr. Siyami Ersek Thorasic and Cardiovascular Surgery Center, Cardiology Clinic, Tibbiye cad 13, Haydarpasa, Kadikoy, Istanbul 34846
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.186050

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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 2022 Oct 5];9:548-9. Available from: https://www.mjdrdypu.org/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 Top

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.  Back to cited text no. 1
    
2.
Penny DJ, Vick GW 3rd. Ventricular septal defect. Lancet 2011;377:1103-12.  Back to cited text no. 2
    
3.
Bove EL, Minich LL, Pridjian AK, Lupinetti FM, Snider AR, Dick M 2nd, 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.  Back to cited text no. 3
    




 

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