Fig. 4

A: The standard apical four-chamber view appears normal with no evidence of any residual defects. B & C: A modified apical four-chamber view with posterior tilt shows an aneurysmal formation in the inferoseptum basal segment. A residual defect around the VSD closing patch is visible in systole and diastole. Arrows highlight the defect in systole and diastole, which is more pronounced during systole. The appearance of the finding is similar to a perimembranous VSD, which is detectable by anterior tilt near the aortic valve. D: A color study from the modified apical four-chamber view revealed that the left-to-right shunt