Percutaneous treatment of ventricular tachycardia, perimembranous ventricular septal defect and patent foramen ovale: a case report.

UN CO RR EC Perimembranous ventricular septal defect in adulthood can be complicated by episodes of sustained ventricular tachycardia [1,2]. The treatment algorithm of both the arrhythmia and congenital cardiac defect can raise some issues, namely medical versus interventional therapies. We report the case of a 40 years old man, admitted for slow ventricular tachycardia with left bundle branch block morphology at 120 bpm, the sinus rhythm was restored with a DC shock cardioversion. During the hospital stay the patient experienced a cryptogenic transient ischemic attack. The transesophageal echocardiogram showed a perimembranous ventricular sepal defect, the maximal diameter measured was 12 mm, with left to right shunt, moderate biventricular enlargement, mild left ventricular systolic dysfunction with ejection fraction around 50%, and a patent foramen ovale with right to left shunt during Valsalva manoeuvre with echocontrast (Fig. 1). The electro-physiological study, performed in another institution, identified the anterior rim of the ventricular sepal defect as the site of reentry; the focus was efficaciously treated with radiofrequency ablation [3]. The patient was treated with amiodarone and beta-blocker for three months, then percutaneous closure of both the perimembranous ventricular sepal defect and the patent foramen ovale were performed in standard fashion [4,5]; because of the morphology and the position, a 16 mm muscular Amplatzer VSD occluder (AGA Medical Corporation, Golden Valley, MN, USA) was chosen for the defect