A RARE CASE OF LARGE VENTRICULAR SEPTAL-DEFECT WITH MINIMAL PULMONARYVASCULAR OBSTRUCTIVE CHANGES IN A 41-YEAR-OLD WOMAN

We describe a case of large ventricular septal defect (VSD) with minim al obstructive changes in the small pulmonary arteries of a 41-year-ol d woman. Before cardiac catheterization, some laboratory findings led us to consider that surgical closure of the defect would not be possib le. However, because hemodynamic examinations showed only mildly eleva ted pulmonary vascular resistance, we patch-closed the VSD successfull y. The histology of lung specimens showed only minimal obstructive cha nges in the small pulmonary arteries. Considering the size of the VSD and the age at which we hemodynamically evaluated the patient, the mil dness of the pulmonary vascular obstructive changes appeared to be aty pical in the natural course of a VSD of this size.