Adult Supracristal Ventricular Septal Defect with Aortic Regurgitation: A Case Report

Abstract

Supracristal Ventricular Septal Defect (VSD) develops Aortic Regurgitation (AR) with the passage of time due to prolapse of the right coronary cusp. It brings clinical attention in early child hood with an incidental continuous murmur, recurrent respiratory tract infection of failure to thrive. This report is about a rare case of 52-year-old female who presented with increased fatiguability since the last six months. Clinical examination revealed the presence of cardiomegaly with holosystolic-diastolic murmur in Left Upper Sternal Border (LUSB). Echocardiography revealed the presence of supracristal VSD with moderate AR without prolapsing aortic leaflet or dilatation of aortic sinus. In view of presence of moderate AR, the patient was advised to be on Angiotensin Receptor Blocker (ARB) with regular follow-up to monitor the progression of AR. Such a late index presentation of supracristal VSD with moderate AR in fifth decade of life has not been described in literature so far. To conclude, nature retards the natural history with bless in disguise.