title: How should I treat a perimembranous interventricular defect following aortic valve replacement surgery?
abstract: BACKGROUND
  A 73-year-old man was admitted to our Institute for repeated episodes of congestive heart failure. The patient was affected by arterial hypertension, dyslipidaemia, severe chronic obstructive pulmonary disease, and recurrent atrial fibrillation. Two months earlier he had undergone aortic valve replacement with a biological prosthesis for severe stenosis. Echocardiography showed a left-to-right shunt localised in the left ventricular outflow tract, normal morphology and function of the aortic valve prosthesis, and a hyperkinetic left ventricle.
  
  
  METHODS
  Physical examination, electrocardiography, transthoracic and transoesophageal echocardiography, right heart catheterisation, left ventricular angiography.
  
  
  METHODS
  Post-surgical perimembranous interventricular defect with a clinically significant left-to-right shunt.
  
  
  RESULTS
  Percutaneous closure with a ventricular septal defect occluder.
authors.affiliation: Invasive Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Coceani
authors.forename: Marco
authors.initials: M
authors.lastname: Ciardetti
authors.forename: Mathis
authors.initials: M
authors.lastname: Schlueter
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.forename: Gennaro
authors.initials: G
authors.lastname: Santoro
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D006333:Heart Failure / Q000209:etiology; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011654:Pulmonary Edema / Q000209:etiology