Supracristal ventricular septal defect with severe right coronary cusp prolapse

The case of a 20 years old male, diagnosed as supracristal ventricular septal defect (vsd) for last 6 years is being presented. he came in emergency department with decompensated congestive cardiac failure. after initial stabilization, he underwent transthoracic echocardiogram which showed large supracristal vsd, severely prolapsing right coronary cusp, severe aortic regurgitation and severe pulmonary hypertension. right heart catheterization was performed which documented reversible pulmonary vascular resistance after high flow oxygen inhalation. he underwent vsd repair, right coronary cusp was excised and aortic valve was replaced by mechanical prosthesis.post operative recovery was uneventful. he was discharged home in one week.