Undiagnosed Perimembranous Ventricular Septal Defect Presenting as Congestive Heart Failure in an Elderly Woman.

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.