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A 24-year-old man was referred to our department for routine follow-up due to a small perimembranous ventricular septal defect (VSD), which had been monitored since his childhood. The patient's vital signs were stable. Auscultation revealed a systolic murmur. Echocardiography showed a highly mobile aneurysmal mass in the left ventricular outflow tract without stenosis or significant aortic insufficiency; there was no flow inside the mass, which appeared to be cystic (Figs. 1 and and2).2). Neither color-flow nor Doppler echocardiographic study showed evidence of left ventricular outflow tract obstruction, yet the VSD was closed.
Ventricular septal defects occur in 20% to 25% of patients who have congenital heart disease.1 The various types of VSD are perimembranous, muscular, inlet, outlet,2 and membranous; this last is the most common form in adults.1 During childhood, some patients have VSDs that close spontaneously by means of aneurysm formation in the septum adjacent to the tricuspid valve. Perhaps the cystic mass in our patient was the result of late aneurysm formation. It appeared to be a tiny, fibrous subaortic mass, too small to obstruct the outflow tract itself but large enough to close the VSD. Because this mass did not cause stenosis or substantial aortic insufficiency, we recommended medical follow-up for this patient: prophylaxis for possible infective endocarditis and routine echocardiography to monitor the progress of aortic insufficiency.
Address for reprints: Maryam Moshkani Farahani, MD, Department of Echocardiography, Baqiatallah University of Medical Sciences, No. 477, Block 18, Shahrak-e-Pass, Sheikh Fazlollah Noori Highway, Tehran 1464894793, Iran