Figure 1

Preoperative imaging. (A) Coronary angiography revealed an acute occlusion (*) of the right coronary artery; (B) revascularization with percutaneous coronary intervention; (C) chronic sub-occlusive lesion of the left anterior descending artery (▲) and a 90% stenosis in the ostium of the first diagonal artery (▼) were also revealed; (D) transesophageal echocardiography showed a muscular ventricular septal defect (VSD); (E) real-time 3-D transesophageal echocardiography depicted a large septal defect measured 38×27mm; (F) the defect was further located in the anterior middle portion of the muscular ventricular septum in the reconstructed image with a view from the left ventricle. The white arrows indicate the location of the VSD.