Ventricular septal defect and aortic insufficiency: Report of three cases

1. (1) Three case reports of probable ventricular septal defect with aortic insufficiency are reported. One was misdiagnosed clinically and discovered at autopsy. The second was diagnosed by clinical means with the aid of cardiac catheterization. The third was diagnosed in a like fashion, with the aid of an aortogram, and proved at surgery (at which time the septal defect was closed, with the production of a moderate infundibular pulmonary stenosis). 2. (2) A discussion of the various differential diagnostic possibilities includes: the lesion described in the case reports, aortic septal defect, patent ductus arteriosus (with or without pulmonary hypertension and pulmonary valvular insufficiency), atrial or ventricular septal-defect with pulmonary hypertension and pulmonary valvular insufficiency, sinus of Valsalva aneurysm with rupture into the right ventricle or pulmonary artery, coronary arteriovenous fistula, arteriovenous fistula of any thoracic systemic vessel near the heart, and anomalous coronary artery communicating with a ventricular chamber. 3. (3) The differential diagnosis can seldom be made on the basis of the physical findings or the history. The electrocardiogram offers some help in excluding the septal defects with pulmonary hypertension, because right ventricular hypertrophy will be present in these circumstances. The cardiac catheterization and the x-ray findings, particularly when proper use is made of injected diodrast, offer the greatest help in making the proper diagnosis.