Mistaken Case of Pulmonary Hypertension: Tricuspid Regurgitation Doppler Signal Contamination from an Apical Ventricular Septal Defect

A 25-year-old female with interstitial lung disease underwent a transthoracic echocardiogram (TTE) for exertional dyspnea. This was initially reported as suspicious for pulmonary hypertension due to a significantly elevated right ventricular systolic pressure (RVSP). Cardiac catheterization showed normal cardiac and pulmonary pressures, ruling out pulmonary hypertension. Review of her TTE images revealed an apically located muscular ventricular septal defect with flow directed towards the tricuspid valve. This created a doppler jet signal that was mistaken to be that of tricuspid regurgitation which led to a miscalculation of the RVSP.