CASE PRESENTATION
A 2-year-old girl was referred to our hospital because of cardiac
murmurs found in 1 month after birth.She had sweating,poor appetite and
a history of thalassemia with her mother.There were no other symptoms
except 2/6 rough systolic murmurs were found between left parasternal
3-4 ribs. The ECG showed I° atrial ventricular block(Figure 1A).Chest
radiograph showed enlarged heart and lung coarse texture(Figure 1B).
Echocardiogram showed a patent foramen ovale(PFO) and an 11.2 mm
ventricular septal defect(VSD), at the upper membranous septum between
the tricuspic and mitrial valve, causing a 3.1mm high-velocity systolic
flow shunt (4 m/s) from left ventricle(LV) to the right atrium(RA) and
the flow persisted to the diastole (Figure 2A and 2B). The pulmonary
artery was a little wider and the pressure was normal according to a
faint pulmonary insufficiency(1.42m/s). But we didn’t find the dilation
of right ventricle or other chambers even if the defect was so large for
her. She underwent the closure of the VSD with an autologous pericardial
patch and surgical suture of PFO using mild hypothermic cardiopulmonary
bypass(CPB). Intraoperatively,the PFO was 3mm×3mm and the VSD was
10mm×8mm above the septal leaflets of the tricuspid valve(TV) but below
the mitral valve(MV)that caused a left ventricular-to-right atrial
communication(Figure 2C and 2D). Her postoperative course was
uneventful,and in the follow-up after 3 months, postoperative
echocardiography also revealed no residual shunt.