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Perimembranous VSD — RACP Adult Medicine MCQ

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ModerateCardiologyPerimembranous VSDRACP Adult Medicine

A 30-year-old man has a loud pansystolic murmur at the left sternal edge with a thrill. ECG shows biventricular hypertrophy. Echo confirms a 10 mm perimembranous VSD with left-to-right shunt. Qp:Qs is 2.5:1. Pulmonary pressures are mildly elevated (PASP 38 mmHg). What is the most likely diagnosis?

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Correct answer: B — Ventricular septal defect

Loud pansystolic murmur with thrill at left sternal edge with significant left-to-right shunt (Qp:Qs >1.5:1) and LV volume overload is a haemodynamically significant VSD. Closure is indicated to prevent progressive pulmonary hypertension and Eisenmenger syndrome. Percutaneous device closure is increasingly available for perimembranous VSDs; surgical closure remains the standard for most.

Reference: ESC – 2024 – ACHD Guidelines