Color Flow Identification of Multiple Ventricular Septal Defects in a Patient with Elevated Pulmonary Vascular Resistance

A 12‐year‐old boy with a large ventricular septal defect and elevated pulmonary vascular resistance had surgical closure of his defect. There was a gradual diminution in pulmonary resistance over a 2‐week period. On the twelfth postoperative day, a new systolic murmur was noted, and an additional small muscular ventricular septal defect was diagnosed by color flow Doppler echocardiography. This defect had not been seen on preoperative left ventricular angiography, nor on several postoperative echocardiography studies. The fall in this patient's pulmonary vascular resistance was analogous to the hemodynamic changes typical of a newborn infant. In that context, the timing of the clinical and echocardiographic appearance of the ventricular septal defect is discussed. (ECHOCARDIOGRAPHY, Volume 8, May 1991)