Calcified pericarditis associated with ventricular septal defect: should we close the hole or open our eyes?

We present the case of a 45-year-old woman with recent onset of dipnea and atrial fibrillation. She was referred to our center for treatment of an associated ventricular septal defect. Echocardiography confirmed the presence of a membranous ventricular septal defect, but also showed signs of constriction. Cardiac computed tomography displayed a severe, diffuse calcified pericarditis. We show that, in adult patients, a minor congenital heart disease can catalyze the clinician’s attention and, like in this case, mask major signs of acquired heart disease.