DÄ internationalArchive3/2020Swiss Cheese Defect of the Ventricular Septum

Clinical Snapshot

Swiss Cheese Defect of the Ventricular Septum

Dtsch Arztebl Int 2020; 117: 40. DOI: 10.3238/arztebl.2020.0040

Kloth, C; Brunner, H; Sagmeister, F

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A 14-year-old boy presented to our hospital with intermittent angina pectoris symptoms on exercise. Echocardiography had already been performed. We carried out cardiac computed tomography (CT) to exclude anomalies of the heart and coronary vessels. This examination showed multiple small, tubular defects in the ventricular septum (arrows) with passage of contrast medium from the left to the right ventricle, corresponding to a ventriculoseptal defect (VSD) with functional left–right shunt (asterisk).

a) Contrast-enhanced computed tomography: transverse four-chamber view of the heart at the level of the mitral valve cusps. Tubular defects in the ventricular septum (arrow). Faint enhancement of contrast at the apex of the right ventricle as sign of left–right shunt. b) Secondary reconstruction: short-axis section with demarcated passage of contrast medium (asterisk) from left to right ventricle (arrow)
Figure
a) Contrast-enhanced computed tomography: transverse four-chamber view of the heart at the level of the mitral valve cusps. Tubular defects in the ventricular septum (arrow). Faint enhancement of contrast at the apex of the right ventricle as sign of left–right shunt. b) Secondary reconstruction: short-axis section with demarcated passage of contrast medium (asterisk) from left to right ventricle (arrow)

VSDs can be divided into membranous defects near the tricuspid and aortic valves, perimembranous defects, and muscular defects. Muscular defects may be single or multiple, are typically of midventricular to apical location, and are also referred to as “Swiss cheese defects” owing to their appearance. The same term is used, albeit rarely, for multifocal atrial defects. The principal differential diagnosis, septal diverticula, was ruled out in this case by the presence of the left–right shunt (asterisk). In accordance with the prevailing clinical practice guidelines, we imposed no measures to prevent endocarditis. Because of the high likelihood of spontaneous closure at this young age, we restricted ourselves to clinical and cardiological follow-up.

Dr. med. Christopher Kloth, MD, Dr. med. Florian Sagmeister, MD, Dr. med. Horst Brunner, MD, Klinik für Diagnostische und interventionelle Radiologie, Uniklinikum Ulm, christopher.kloth@uniklinik-ulm.de

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Kloth C, Sagmeister F, Brunner H: Swiss cheese defect of the ventricular septum. Dtsch Arztebl Int 2020; 117: . DOI: 10.3238/arztebl.2020.0040

a) Contrast-enhanced computed tomography: transverse four-chamber view of the heart at the level of the mitral valve cusps. Tubular defects in the ventricular septum (arrow). Faint enhancement of contrast at the apex of the right ventricle as sign of left–right shunt. b) Secondary reconstruction: short-axis section with demarcated passage of contrast medium (asterisk) from left to right ventricle (arrow)
Figure
a) Contrast-enhanced computed tomography: transverse four-chamber view of the heart at the level of the mitral valve cusps. Tubular defects in the ventricular septum (arrow). Faint enhancement of contrast at the apex of the right ventricle as sign of left–right shunt. b) Secondary reconstruction: short-axis section with demarcated passage of contrast medium (asterisk) from left to right ventricle (arrow)