Atrial septal defects (ASDs) and ventricular septal defects (VSDs) account for the majority of congenital heart disease and may remain clinically relevant from infancy into adulthood. Echocardiography is the gold standard for diagnosis and detailed anatomical assessment of these defects; however, the electrocardiogram (ECG) may provide additional pathophysiological and prognostic insights. This review summarizes ECG findings in ASD and VSD before and after repair, with respect to the effects of defect type, timing of intervention, and postoperative evolution of electrical disturbances. A structured literature search was conducted to identify studies reporting ECG or rhythm abnormalities before and after repair. In hemodynamically significant ASD, ECG changes before repair generally correlate with chronic right-sided chamber volume overload. Secundum defects present with right-axis deviation and incomplete right bundle branch block. Primum defects are mainly associated with left-axis deviation and atrioventricular conduction delay, whereas sinus venosus defects may present with sinus node dysfunction. After closure, right-sided overload markers may return to normal; however, persistent atrial arrhythmias and conduction-system lesions frequently occur. In VSD, preoperative findings may include a normal ECG in small restrictive defects, to left, right, or combined ventricular overload patterns when associated with elevated left ventricle preload or right ventricle afterload. After surgery, the ECG tends to reflect evolving conduction-system injury and late rhythm-related vulnerability, such as right bundle branch block, atrioventricular block, QTc prolongation, progressive PR/QRS widening, and late complete atrioventricular block. Future studies with standardized timing and outcome-related follow-up are warranted to solidify the clinical relevance of specific ECG findings.

Pectus excavatum can rarely result in clinically significant right ventricular (RV) compression, leading to impaired diastolic filling, reduced stroke volume, and secondary biventricular dysfunction involving both the right and left ventricles. We report a 19-year-old male who presented with progressive exertional dyspnea and was found to have severe pectus excavatum with a Haller index of 5.8 on cardiac magnetic resonance imaging and 3.6 on computed tomography. Multimodal cardiac evaluation demonstrated focal RV compression, moderate RV systolic dysfunction on cardiac MRI with a right ventricular ejection fraction (RVEF) of 31%, mild left ventricular (LV) systolic dysfunction with an ejection fraction of 44%-45%, and trivial mitral and tricuspid regurgitation. Spirometry was overall normal, without obstructive changes or exercise-associated bronchoconstriction, and electrocardiography revealed marked right-axis deviation. Coronary computed tomography angiography demonstrated normal coronary anatomy, while cardiac MRI showed no delayed gadolinium enhancement to suggest myocardial scar or infiltrative cardiomyopathy. In the absence of alternative clinical or imaging evidence for another cardiomyopathic process, the patient met morphologic and physiologic criteria for surgical repair and underwent minimally invasive correction with pectus bar placement without complication. At five-month follow-up, he reported resolution of dyspnea, although repeat postoperative cardiac imaging had not yet been performed. This case emphasizes the importance of recognizing extrinsic RV compression from pectus excavatum as a surgically correctable and likely reversible contributor to ventricular dysfunction and highlights the role of comprehensive imaging in guiding timely surgical intervention.

Acute pulmonary embolism (APE) and chronic thromboembolic pulmonary hypertension (CTEPH) both causedyspnoea and right ventricular (RV) overload, but require diff erent management. Electrocardiography (ECG) is widelyavailable, yet its role in distinguishing APE from CTEPH remains underexplored. We aimed to identify ECG parametersdiff erentiating APE from CTEPH and develop a predictive model.We included 184 patients: those hospitalized with intermediate-high-risk APE and patients with confi rmed CTEPH.ECG parameters were analyzed using logistic regression, and a predictive equation and simplifi ed scoring model(CTEPH ECG SCORE) were developed and validated.CTEPH patients showed higher rates of right axis deviation (RAD), qR pattern in V1, increased precordial ECGvoltage, and prolonged P-wave duration, whereas APE patients had higher heart rates, more frequent right bundlebranch blocks, and greater T-wave inversions (TWI). The CTEPH ECG SCORE distinguished CTEPH from APE with highaccuracy (AUC = 0.95) and was calculated as follows: CTEPH ECG SCORE = 0.5 + (4 × RAD) + (2 × Sokolow-Lyonindex) – (3.5 × HR 100) – (0.5 × TWI range).ECG can serve as a valuable tool for distinguishing CTEPH from APE.

Pulmonary valve stenosis is a congenital heart disease that is usually diagnosed during childhood, while presentation in adulthood is uncommon and may lead to delayed diagnosis. We report the case of a 21-year-old patient with no significant medical history who presented with a six-month history of exertional dyspnea and constrictive chest pain. Electrocardiography showed right axis deviation with signs of right ventricular hypertrophy, and chest radiography revealed dilatation of the left pulmonary artery. Transthoracic echocardiography demonstrated severe valvular pulmonary stenosis with a peak velocity of 4.53 m/s and a maximum systolic gradient of 82.23 mmHg, associated with right ventricular hypertrophy and preserved systolic function, without evidence of pulmonary hypertension. Computed tomography pulmonary angiography confirmed focal post-stenotic dilatation of the left pulmonary artery. After a multidisciplinary discussion, balloon pulmonary valvuloplasty was recommended. This case highlights the importance of considering congenital pulmonary valve stenosis in young adults presenting with exertional symptoms and underscores the challenges of access to advanced interventional therapies in resource-limited settings.