An Unusual Finding in a Patient With a Ventricular Septal Defect: A “Splitting” Image

A 61-YEAR-OLD MAN (weight: 99 kg; height: 179 cm) with progressive palpitations and fatigue, a known small restrictive ventricular septal defect with a left-to-right shunt (maximum velocity of 4.8 meters/s; peak pressure gradient of 94 mmHg), atrial fibrillation, and tricuspid regurgitation was referred for percutaneous pulmonary vein isolation. Transthoracic echocardiography demonstrated left ventricular diastolic dysfunction, a muscular ventricular septal defect (Fig 1), and a normal, functioning, but modestly dilated right ventricle with an estimated right ventricular systolic pressure of 40 mmHg.