Resident of Cardiology , Rajaie Cardiovascular, Medical and Research Center - Tehran University of medical science, Tehran Iran
Corresponding Author: M J Hashemi MD , Associated professor of Interventional cardiology, Rajaie Cardiovascular, Medical and Research Center - Tehran University of Medical Science, Tehran Iran
A 45-year-old man was referred to our hospital for angina pectoris 2 days after an anterolateral myocardial infarction. On admission, he had a blood pressure of 100/70 mm Hg and holosystolic murmur at the left sternal border. Transthoracic echocardiography showed akinesia in the apicoseptal, apicoinferior, and apicoposterior regions of the left ventricle, with large apical aneurysm and clot. There was also a large apical ventricular septal defect (VSD) with a significant left-to-right shunt. During cardiac catheterization, the only abnormality found beside the VSD was myocardial bridging in the mid part of the left anterior descending coronary artery and ostial lesion in the first diagonal artery. The patient was scheduled for bypass surgery and VSD closure.