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Very late presentation ventricular septal defect following myocardial infarction

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A 64-year-old man was admitted to hospital with shortness of breath and abdominal swelling. His background history included an inferior ST-elevation myocardial infarction (MI), 18 months previously, treated by stenting of his right coronary artery. On examination, there was a pansystolic murmur and signs of right heart failure, with markedly elevated jugular venous pressure, ascites and peripheral oedema. After treatment elsewhere with diuretics and intermittent paracentesis, he was transferred to our …

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