Current Status of Surgical Treatment of Ventricular Septal Defect

¹ The Cora and Webb Mading Department of Surgery, Baylor University College of Medicine, and the surgical services of the Jefferson Davis, Methodist, and Veterans Administration Hospitals.

Surgical repair of ventricular septal defect is now an established precedure in cardiac surgery using a pump oxygenator for temporary cardiopulmonary bypass. From a collected series of 345 patients undergoing operation during bypass for a variety of congenital and acquired cardiovascular lesions, 130 had isolated ventricular septal defect. From this experience ventricular defects appear to be the most common congenital cardiac defects requiring open heart surgery.

Analysis of the experience reveals highly satisfactory results among those between ages two and 15 years. Among 71 patients in this age group there were five deaths or a mortality of 7 per cent. Risk of operation during infancy is substantially higher. However, a salvage of 70 per cent of patients less than two years of age justifies operation even in these critically ill patients.

Pulmonary hypertension is frequently associated with ventricular septal defect. As pulmonary vascular resistance increases in these patients, reversal of the intracardiac shunt may lead to cyanosis. The extent of pulmonary vascular changes influences the risk of operation. Although patients with a so-called Eisenmenger's complex associated with cyanosis, clubbed nails, polycythemia, and right ventricular hypertrophy are not satisfactory candidates for surgical treatment, we have operated successfully upon a number of patients with balanced or combined left to right and right to left shunts. Future developments may help control the physiologic effects of the increased pulmonary vascular resistance and thus make possible operative correction in almost all patients with ventricular septal defects.