Muscular Defects in the Ventricular Septum

Although defects in the muscular part of the inter-ventricular septum have been recognized since the time of Galen, they are rare. Selzer (1954) states that 90 per cent of isolated ventricular septal defects and virtually all those occurring with other malformations of the heart are located in the membranous septum and he believes that muscular defects are of no clinical importance since they are usually small and decrease in size or close during systole. A similar opinion is held by Kaplan and Robinson (1954) who consider that there is a remarkable absence of symptoms with defects in the muscular portion of the inter-ventricular septum. Such congenital defects may, however, be associated with a dramatic clinical picture as in the case now reported. CASE REPORT A married woman, aged 21 years, was admitted as an emergency with hemoptysis. She had been short of breath on exertion since infancy and had suffered from coughs and colds every winter. Her parents had noticed that her lips became blue when she was breathless and for this reason had taken her at the age of five years for examination by one of us (J.W.B.) when, on the basis of a loud prncordial systolic murmur, a ventricular septal defect was diagnosed. From the age of six she had had recurrent nose bleeding and her breathlessness on exertion had become worse but she was not cyanosed other than on exertion. At the age of twenty years she had coughed up a little bright red blood and after five weeks of repeated small hamoptyses had suddenly coughed up a pint of blood. A year later she had had further hamoptyses and this had con- tinued until five days before her admission when she had complained of a bubbling sensation in her chest and coughed up a further pint of blood. Three days after admission she had a further profuse hmemoptysis and died.