Additional Comment Is Necessary
The Clinical Snapshot by Kloth et al. shows a very common anatomical particularity without any relevant pathological significance (1). In many pediatric cardiology practices and pediatric hospitals, such a clinical picture is presented almost on a daily basis: a young person with intermittent thoracic pain.
The diagnostic evaluation by a pediatric cardiologist comprises the medical history, examination, ECG, if required long term and/or stress ECG, echocardiography, and a cardiac cause can be ruled out in almost all cases.
Computed tomography is absolutely redundant. The harmless muscular ventricular defect has nothing to do with the thoracic pain. A high spontaneous closure rate in this age group (14 years) is not to be expected, whereas in infants it is, up to the age of 10 in occasional cases.
The classification of ventricular septum defects is not correct, and the term “Swiss cheese effect” is not used less often for atrial defects, but not at all.
The decision about treatment depends on the hemodynamic relevance. And in such small defects there is no such relevance.
Dr. med. Hubert Gerleve
Kinder- und Jugendklinik
Christophorus-Kliniken GmbH Coesfeld
Akademisches Lehrkrankenhaus der Universität Münster
|1.||Kloth C, Sagmeister F, Brunner H: Swiss cheese defect of the ventricular septum. Dtsch Arztebl Int 2020; 117: 40 VOLLTEXT|