clinically , he had grade iv pansystolic murmur along left lower sternal border suggestive of ventricular septal defect . echocardiography showed irregular borders of interventricular septum and extensive muscle bundles inside both left ventricle with obliteration apex [ figure 1a and video 1a ] . on color doppler examination , multiple tiny ventricular septal defects were noted with left to right shunt [ figure 1b and video 1b ] . transthoracic echocardiography showing multiple mesh work of large trabeculations and profound recesses obliterating the left ventricular apex ( a ) , and color doppler showing a multiple tiny ventricular septal defect ( b ) cardiac catheterization was performed to assess the shunt and number of ventricular septal defects . there was insignificant step - up at right ventricular level and pulmonary artery pressure was normal . left ventricular angiography in left anterior oblique ( lao ) cranial projection showed irregular interventricular septum with multiple recesses and filling defects [ figure 2a and video 2a ] . left ventricular angiography repeated in right anterior oblique projection showed multiple crypts and recesses along diaphragmatic surface of the left ventricle [ figure 2b and video 2b ] . right ventricular angiography in lao cranial projection showed normal size right ventricle with normal function . invasive ventriculography showing irregular inter - vetricular septum with multiple trabeculations and filling defects ( a ) , deep recesses ( b ) he underwent cardiac computed tomography ( ct ) , which showed irregular meshwork of muscle bundles obliterating the left ventricular apex [ figure 3a and 3b ] . there were multiple prominent trabeculations , crypts , with deep serpiginous recesses predominantly involving the interventricular septum [ figure 3c and 3d ] resulting multiple ventricular septal defects . the cardiac ct features were consistent with non - compaction of the left ventricle with predominant affliction of the interventricular septum with multiple tiny muscular ventricular septal defects . contrast - enhanced cardiac computed tomography scan showing obliterated left ventricular apex with multiple prominent trabeculations ( a and b ) with inter - trabecular recesses predominantly involving the muscular inter - ventricular septum ( c and d ) left ventricular non - compaction ( lvnc ) is a congenital cardiomyopathy characterized by deep ventricular trabeculations thought to be due to an arrest of myocardial morphogenesis . though left ventricular apical and inferior wall segments are most commonly involved in lvnc , involvement of the septum is extremely rare . although echocardiography has been the diagnostic test of choice for non - compaction , other modalities like ct and magnetic resonance imaging have been used for the diagnosis , especially in cases with poor echocardiographic image quality . in our patient , cardiac ct enabled the non - invasive diagnosis of lvnc ; thus , highlighting the potential utility of this imaging test for elucidating this rare entity and invasive ventriculography demonstrated associated with multiple tiny ventricular septal defects , which is undescribed in english literature . further , this case illustrates the integrative nature of various cardiac imaging modalities in diagnosis of this rare clinical entity .
left ventricular non - compaction ( lvnc ) is a congenital cardiomyopathy characterized by deep ventricular trabeculations thought to be due to an arrest of myocardial morphogenesis . 
 integration of various cardiac imaging modalities such as echocardiography , cardiac computed tomography and cardiac magnetic resonance imaging help in the diagnosis of this rare clinical entity . 
 we describe a child with rare variant of lvnc with predominant involvement of interventricular septum resulting in multiple ventricular septal defects .