Muscular ventricular septal defect after mitral and aortic valve replacement

Abstract

From September 2007 to December 2008, five patients aged 54–69 years were admitted to our institution for cardiac rehabilitation after surgical cardiac valve replacement (table 1). Successful replacement of the aortic valve was performed in four of the patients and mitral valve replacement in the other. All patients received mechanical prosthetic valves (ATS medical) and had a history of dyspnoea, fatigue and exercise limitation. Physical examination on admission did not reveal signs of congestion in any of the patients. The admission electrocardiogram showed sinus rhythm or atrial fibrillation (patient 4) and signs of left ventricular hypertrophy in 3 of 5 patients. Doppler echocardiography revealed a restrictive muscular ventricular septal defect (fig. 1, 3, 4, 5 and 6) with Qp/Qs <1.4 in all of the patients. The function of the prosthetic valves was normal and in one patient (patient 5) systolic pump function was moderately reduced. Echocardiographic follow-up revealed spontaneous closure of the septal perforation in four of the five patients (fig. 2). In one patient the septal defect persisted for one and a half years after surgery, but he remained asymptomatic without deterioration of left ventricular function or increased pulmonary artery systolic pressure.