case_images: PMC10859041_01
case_images: ECG of the patient showing fast atrial fibrillation (heart rate of 122/minute).
case_images: 10.1177_11795476241231140-fig1.jpg
case_images: PMC10859041_01_10.1177_11795476241231140-fig1.jpg
case_images: fig1-11795476241231140
case_images: His ECG (Figure 1) showed fast atrial fibrillation with heart rate of 122 beats per minute.
case_images: Postero-anterior and lateral Chest X-ray of the patient showing cardiomegaly and upper lobe blood diversion.
case_images: 10.1177_11795476241231140-fig2.jpg
case_images: PMC10859041_01_10.1177_11795476241231140-fig2.jpg
case_images: fig2-11795476241231140
case_images: Chest X-ray (Figure 2) showed cardiomegaly with upper lobe diversion and prominent pulmonary trunk with dilated pulmonary arteries suggestive of pulmonary hypertension.
case_images: Epical 4 chamber view 2-dimension echocardiogram showing a large perimembranous ventricular septal defect of diameter 2.8 cm (arrows) and biatrial dilatation.
case_images: 10.1177_11795476241231140-fig3.jpg
case_images: PMC10859041_01_10.1177_11795476241231140-fig3.jpg
case_images: fig3-11795476241231140
case_images: Transthoracic echocardiogram (Figures 3-6) showed a large perimembraneous VSD of 2.8 cm with left to right shunting, severe pulmonary hypertension (right ventricular (RV) systolic pressure 112.5 mmHg), with dilation of the pulmonary trunk (3.6 cm) and pulmonary arteries, RV hypertrophy with dilatation, and right atrial dilatation.
case_images: Continuous wave spectral doppler echocardiogram across the tricuspid valve giving peak tricuspid regurgitant velocity (TR max PG) of 102.5 mmHg and estimated right ventricular systolic pressure (RVSP) of 112.5 mmHg giving a right atrial pressure of 10 mmHg.
case_images: 10.1177_11795476241231140-fig4.jpg
case_images: PMC10859041_01_10.1177_11795476241231140-fig4.jpg
case_images: fig4-11795476241231140
case_images: Transthoracic echocardiogram (Figures 3-6) showed a large perimembraneous VSD of 2.8 cm with left to right shunting, severe pulmonary hypertension (right ventricular (RV) systolic pressure 112.5 mmHg), with dilation of the pulmonary trunk (3.6 cm) and pulmonary arteries, RV hypertrophy with dilatation, and right atrial dilatation.
case_images: Parasternal short axis view 2-dimension echocardiogram showing dilated pulmonary trunk of diameter 3.6 cm (long arrow) and pulmonary arteries (short arrows).
case_images: 10.1177_11795476241231140-fig5.jpg
case_images: PMC10859041_01_10.1177_11795476241231140-fig5.jpg
case_images: fig5-11795476241231140
case_images: Transthoracic echocardiogram (Figures 3-6) showed a large perimembraneous VSD of 2.8 cm with left to right shunting, severe pulmonary hypertension (right ventricular (RV) systolic pressure 112.5 mmHg), with dilation of the pulmonary trunk (3.6 cm) and pulmonary arteries, RV hypertrophy with dilatation, and right atrial dilatation.
case_images: Parasternal long axis view 2-dimension echocardiogram showing thickened mitral valve leaflets with mild calcifications (short arrow) a large perimembranous ventricular septal defect (long arrow), dilated left atrium both ventricles dilated.
case_images: 10.1177_11795476241231140-fig6.jpg
case_images: PMC10859041_01_10.1177_11795476241231140-fig6.jpg
case_images: fig6-11795476241231140
case_images: Transthoracic echocardiogram (Figures 3-6) showed a large perimembraneous VSD of 2.8 cm with left to right shunting, severe pulmonary hypertension (right ventricular (RV) systolic pressure 112.5 mmHg), with dilation of the pulmonary trunk (3.6 cm) and pulmonary arteries, RV hypertrophy with dilatation, and right atrial dilatation.