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Preoperative Visualization of a Muscular Ventricular Septal Defect by 64-Slice Cardiac Computed Tomography

A 21-year-old man presented to a primary care physician for a general evaluation. He had a past medical history of a “heart murmur” present since childhood. His only complaint was mild increased fatigability with exertion; he had no dyspnea at rest. Physical examination was remarkable for a 2/6 systolic ejection murmur heard throughout the precordium. A transthoracic echocardiogram showed a muscular ventricular septal defect (VSD) with a mildly dilated right ventricle and an elevated right ventricular systolic pressure of 80 mm Hg. The patient was evaluated for an elective repair of the VSD. Preoperative assessment included a cardiac computed tomography (CT) angiogram (Lightspeed VCT, GE Healthcare) to rule out coronary disease. The CT scan clearly demonstrated the muscular VSD (Figure) and showed normal coronary arteries.