Endocrine Abstracts

Ventricular septal defect (VSD) is a congenital heart malformation that has been identified as an abnormal communication between the ventricles. The defect can be found at any part of the septum. A large VSD allows unimpeded left-right shunt with subsequent development of pulmonary hypertension and shunt reversal. The shunt reversal leads to development of Eisenmenger syndrome. We present the case of 40-year-old female with ventricular septal defect with Eisenmenger syndrome and amiodarone induced thyrotoxicosis. At the time when diagnosis was made, transthoracic echocardiogram showed dilated left atrium with mitral regurgitation 1-2+. In the membranous part of the septum there was defect in size 18-19 mm, with a bi-directional shunt dominant right - left shunt. The right atrium and right ventricle were dilated, systolic pressure in right ventricle was 104 mmHg with central venous pressure (CVP) estimated at 15 mmHg, 25 mmHg inferior vena cava, deep inspirium collapse <50%, with impaired systolic function. Right catheterization revealed a great gradient of a difference between medium pulmonary artery pressure (65 mmHg) and the medium pressure at the level of capillaries / arterioles (6 mmHg) which indicates a high resistance at the level of arterioles according to the Eisenmenger syndrome. Patient had had permanent atrial fibrillation as well as episodes of non sustained ventricular tachycardia. At first, amiodarone was induced with satisfying therapeutic response. Since patient had had thyrotoxic crisis, amiodarone was discontinued and implantable cardioverter defibrillator (ICD) was induced. Amiodarone induced thyrotoxicosis occurs in 2-12% patients on chronic amiodarone treatment. Since combination of amiodarone and ICD was the only therapeutic option for this patient, strict control of thyroid status had to be maintained.

Key words: ventricular septal defect, amiodarone, thyrotoxicosis