Undiagnosed Perimembranous Ventricular Septal Defect Presenting as Congestive Heart Failure in an Elderly Woman

Background: A hemodynamically significant ventricular septal defect (VSD) typically manifests in children but is uncommon in adults. The long-term outcomes of unrepaired small VSDs in the elderly population are not well known because they rarely become hemodynamically significant. Case Summary: A 77...

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Main Authors: Varshitha T. Panduranga, MD, Maureen Masara, MD, Adam Kurnick, MD, Varsha Talanki, BSc, Harshith P. Chandrakumar, MD, Siddharth Dubey, MD, Sabu John, MD
Format: Article
Language:English
Published: Elsevier 2025-07-01
Series:JACC: Case Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S2666084925006795
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Summary:Background: A hemodynamically significant ventricular septal defect (VSD) typically manifests in children but is uncommon in adults. The long-term outcomes of unrepaired small VSDs in the elderly population are not well known because they rarely become hemodynamically significant. Case Summary: A 77-year-old woman presented with newonset heart failure and atrial fibrillation. A transthoracic echocardiogram showed a small peri-membranous (VSD) with “windsock deformity,” a left-to-right shunt, and severely reduced ejection fraction. She experienced cardiogenic shock requiring inotropic support and later died. Discussion: Unrepaired small VSDs presenting as acute heart failure in elderly patients have rarely been reported. This unique case helps to inform other practitioners of potential long-term outcomes of unrepaired small VSDs. Take-Home Messages: Unrepaired VSDs in adults present a complex clinical challenge because of their uncertain long-term outcomes and limited data. This rare presentation in advanced age underscores the importance of early recognition and timely management.
ISSN:2666-0849