Ventricular Septal Defect in an Octogenarian: A Case Report of VSD Surgical Repair Concomitant with Coronary Artery Bypass and Valvular Surgery

Abstract

Finding an untreated or asymptomatic large ventricular septal defect (VSD) in an elderly patient is uncommon. The present case was an 81-year-old man who suffered from acute myocardial infarction due to three-vessel coronary disease, mitral and tricuspid valve insufficiency, and high-flow perimembranous VSD (Qp/Qs 2.3). Although the patient was elderly and the VSD had been asymptomatic for a long time, we considered that high-flow VSD and valve diseases should be repaired simultaneously with coronary disease. Then, he underwent elective surgery, namely, VSD patch repair concomitant with coronary artery bypass grafting, and mitral and tricuspid annuloplasty. His postoperative course was uneventful. We conclude that, even for an octogenarian, surgical repair of VSD is recommendable, if surgical indications are appropriate.

Figure 1

Chest X-ray at admission: significant pulmonary congestion and reduced bilateral lung permeability due to pleural effusion were seen (cardiothoracic rate of 62%).

Figure 2

Echocardiography: short axis (a) and apical 4-chamber (b) view. Perimembranous ventricular septal defect L → R flow and moderate tricuspid regurgitation flow were seen.

Figure 3

Perimembranous inlet-type VSD and membranous aneurysm (↑). The right-upper edge of the membranous aneurysm was tightly adhered and formed a mass with part of the tricuspid septal leaflet. The diameter of the VSD orifice was 8 mm while the original VSD size was speculated to be at least 15 × 20 mm.