An operative case of left ventricular-right atrial communication complicated with aortic valve stenosis and regurgitation

A 70-year-old woman suffering from aortic valve stenosis and regurgitation and tricuspid valve regurgitation was admitted to our hospital. At the operation, the right atrium and both ventricles were dilated, and a thrill was felt over the aortic root and right atrium. The aortic valve was bicuspid and heavily calcified. After aortic leaflets were resected, a defect was seen in the left ventricle. Then the right atrium was opened. The defect was located in the atrioventricular membranous septum just above the septal leaflet of the tricuspid valve. The defect was diagnosed to be a left ventricular-right atrial communication (group I according to Riemenschneider's classification). The defect was repaired directly and then the aortic valve was replaced with a prosthesis. After the operation, the heart murmur disappeared. Eleven days after the operation, the patient developed a transient complete AV block for a month.