JACC Case Rep. 2025 Jul 2;30(17):103901. doi: 10.1016/j.jaccas.2025.103901.
ABSTRACT
BACKGROUND: A hemodynamically significant ventricular septal defect (VSD) typically manifests in children but is uncommon in adults. The long-term outcomes of unrepaired small VSDs in the elderly population are not well known because they rarely become hemodynamically significant.
CASE SUMMARY: A 77-year-old woman presented with newonset heart failure and atrial fibrillation. A transthoracic echocardiogram showed a small peri-membranous (VSD) with "windsock deformity," a left-to-right shunt, and severely reduced ejection fraction. She experienced cardiogenic shock requiring inotropic support and later died.
DISCUSSION: Unrepaired small VSDs presenting as acute heart failure in elderly patients have rarely been reported. This unique case helps to inform other practitioners of potential long-term outcomes of unrepaired small VSDs.
TAKE-HOME MESSAGES: Unrepaired VSDs in adults present a complex clinical challenge because of their uncertain long-term outcomes and limited data. This rare presentation in advanced age underscores the importance of early recognition and timely management.
PMID:40615207 | DOI:10.1016/j.jaccas.2025.103901