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The underlying question that prompted computed tomography scanning was whether the patient had a possible coronary anomaly (1). This arose after referral from the treating physician in private practice and prior diagnostic evaluation (including echocardiography). According to the consensus recommendations from 2012 (jointly set out by Diagnosis-Related Groups, the German Society of Cardiology (DGK), and the Germany Society of Pediatric Cardiology [DGPK]), this is a class I recommendation for undertaking coronary computed tomography—the indication was therefore in accordance with the guidelines. We did not intend to create the impression that the clinical symptoms were associated with the finding, which was clearly incidental. According to the literature, the spontaneous closure rate notably decreases after the 10th year of life; treatment seems unnecessary at the present time, but this is the responsibility of the treating pediatric cardiologists. We mentioned preventing endocarditis in order to underline the non-existent therapeutic relevance of this incidental finding. We are pleased that in responding to your comments we were given a broader opportunity to explain the importance of non-invasive cardiac imaging.

DOI: 10.3238/arztebl.2020.0327b

On behalf of the authors

Dr. med. Christopher Kloth

Abteilung für Diagnostische und Interventionelle Radiologie

Universitatsklinikum Ulm

christopher.kloth@uniklinik-ulm.de

Conflict of interest statement

The authors of both contributions declare that no conflict of interest exists.

1.
Kloth C, Sagmeister F, Brunner H: Swiss cheese defect of the ventricular septum. Dtsch Arztebl Int 2020; 117: 40 VOLLTEXT
1.Kloth C, Sagmeister F, Brunner H: Swiss cheese defect of the ventricular septum. Dtsch Arztebl Int 2020; 117: 40 VOLLTEXT

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