Key result
CCTA reveals a small muscular VSD causing a fixed mid-anteroseptal SPECT perfusion defect.
Why the study?
An isolated fixed septal perfusion abnormality on myocardial perfusion SPECT in patients without prior MI may be caused by a muscular ventricular septal defect, which requires further evaluation.
Case Report (n=1)
A ventricular septal defect should be considered in the differential diagnosis of an isolated fixed septal perfusion abnormality on SPECT in patients without prior MI.
May warrant considering VSD in fixed SPECT defects with normal coronaries; leaves open whether this alters routine interpretation protocols.
A 47-year-old woman with no history of CAD presented with an episode of left-sided atypical chest pain. Her work-up was negative for acute MI. She underwent a myocardial perfusion Tc-99m tetrofosmin SPECT study to rule out myocardial ischemia. The SPECT images revealed a small nonreversible mid-anteroseptal perfusion defect. For additional evaluation coronary computed tomography angiography was performed. This revealed normal coronary arteries and demonstrated a small muscular ventricular septal defect which corresponded to the location of the fixed perfusion defect on the SPECT images. The presence of the ventricular septal defect should be considered in differential diagnosis of an isolated fixed septal perfusion abnormality on SPECT images in patients with no history of prior MI.
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Abidov et al. (2009) conducted a case report in Atypical chest pain (n=1). Myocardial perfusion Tc-99m tetrofosmin SPECT and Cardiac Computed Tomography Angiography was evaluated on Identification of the cause of perfusion defect. A small muscular ventricular septal defect was identified on cardiac computed tomography angiography as the cause of an isolated fixed mid-anteroseptal perfusion defect on SPECT imaging.
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