Ventricular septal defect – incidental diagnosis

Introduction: Ventricular septal defect, a simple con-genital malformation, has an incidence of approxima-tely 30-40% of all cases of congenital heart disease. The hemodynamic consequences depend on the size of the defect and the pulmonary resistances. Possible neuro-logical complications can be encountered by unopera-ted patients.
Methods: We present the case of a 33 year old, smo-ker, who is hospitalized for a polymorphic symptom based on episodes of consciousness suspension (4 epi-sodes in the last 2 years) preceded by visual disturban-ces. Anamnestic, one of the crisis was accompanied by sphincter relaxation and another crisis of tonic-clonic seizures (observed by entourage).
Results: T he clinical examination reveals intense ho-losistolic breathing, maximum audible parasternal left, irradiation over the entire precordial area „in the whe-el spoke“ and irradiation on both carotid, pectus ex-cavatum. Echocardiography reveals ventricular septal defect in the membranous part, 8-10 mm in diameter with shunt left-right and LV-RV gradient 50 mmHg. It is important to note the major headache and verti-go when switching from hypotension to orthostatism without the variability of blood pressure and/or heart rate.
Conclusions: The therapeutic strategy is surgical. Clo-sing the defect aims not only at clinical improvement of symptoms but also prevention of complications (pa-radoxical embolism, arrhythmias, syncope episodes, pulmonary hypertension). Monitoring this category of patients is complex and requires optimum care in spe-cialized centers.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)