case_images: PMC5864802_01
case_images: (a) Transthoracic color Doppler echocardiography demonstrating a ventricular septal defect with a left-to-right shunt in the apical 4-chamber view. (b) Transoesophageal echocardiography revealed prolapse of the anterior mitral leaflet (arrow) and restriction of the ventricular septal defect by the tricuspid septal leaflet (asterisk) in the 38  view, (c) prolapse of the P2L scallop of the posterior mitral leaflet (arrow) in the mid-oesophageal 0  view, and (d) bicuspid aortic valve (asterisk) in the mid-oesophageal 35  view. (e, f) Transoesophageal echocardiography revealed a membranous ventricular septal defect with a left-to-right shunt in the mid-oesophageal 0  view (arrow). LA - left atrium; LV - left ventricle; Mv - mitral valve; RA - right atrium; RV - right ventricle; Tv - tricuspid valve
case_images: AJC-19-E1-g001.jpg
case_images: PMC5864802_01_AJC-19-E1-g001.jpg
case_images: F1
case_images: In the apical 4-chamber view, a 5-mm, membranous ventricular septal defect (VSD) was seen in the baseline portion of the interventricular septum (Fig. 1a). Transesophageal echocardiography revealed prolapse of the anterior mitral leaflet in the 38  view (Fig. 1b, arrow), prolapse of the P2L scallop of the posterior mitral leaflet in the mid-esophageal 0  view according to the modified Carpentier classification (Fig. 1c, arrow), and CBAV in the 35  view (Fig. 1d, a sterisk). In the mid-esophageal 0  view, a 7-mm, small VSD in the membranous septum with a left-to-right shunt was observed (Fig. 1e, 1f, arrow). The VSD and left-to-right shunt were restricted by the tricuspid septal leaflet (Fig. 1b, asterisk).