Georg-Fredrik Saltzman

Combined ventricular septal defect and aortic insufficiency.

Saltzm,an Catheterization and examination of the heart and great vessels with contrast media have greatly increased our possibilities of making a correct diagnosis in living subjects even in the case of complicated congenital malformations. Using a few cases as a basis for discussion, the diagnostic possibilities in combined ventricular septal defect and aortic insufficiency are treated in this paper. The question of the differential diagnosis from patent tluctus arteriosus, which previously has always caused great difficulties, is given special attention. The combination of a ventricular septal defect and insufficiency of the aortic orifice has been mentioned in several case reports (LACBRY, ROCTIER end SOULI~, TAUSSIG and SEMASS, HUKST and SCHENM, SOULIE, ROUTIER and BERNAL, EDWARDS et coll., Woon, MAGIDSON and WILSON), and has been discussed by SELZER and LAQ~JEUR. A case published by ABROTT, in which a ruptured meurysm of the aortic sinus was combined with insufficiency of the aortic orifice, may, haemodynamically speaking, be regarded as belonging to the same category. The anatomic relationships were clearly demonstrated at autopsy in six out of the seven previously described cases. All had a defect in the pars membranacea of the ventricular septum immediately below the semilunar valves. In every case, at least one of the semilunar valves was deformed to such a degree that the aortic orifice could not be properly closed. The nature of the valvular malformation, whether congenital or acquired, was difficult to decide. In one or two instances, it seemed likely that the defective valve had been exposed to inflammatory processes. All patients had three semilunar valves.