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.