Congenital ventricular septal defect

From 1964-1978, 117 patients were operated on because of isolated congenital ventricular septal defect (VSD). Closure of the defect was performed through the right ventricle in 93 patients and through the right atrium in 22. In one patient the VSD was closed through the left ventricle and in an additional patient the transpulmonary artery route was used. Six patients (5.1%) died in the immediate postoperative period: all had had severe pulmonary hypertension. One patient died six months after operation. Seven patients were reoperated on because of residual significant shunt, without mortality. The surviving 110 patients improved significantly and are in functional NYHA Class I or II. Based on these results, we recommend closure of congenital isolated VSD in asymptomatic children between 2-5 years of age. Symptomatic infants with either intractable heart failure or pulmonary hypertension should be operated on early with the aid of deep hypothermia and total circulatory arrest. VSD types II and III are closed through the right atrium. The right ventricular approach is used for those with VSD and associated anomalies. The transpulmonary route is recommended for Type I, providing there has been precise preoperative anatomical diagnosis. Closure of multiple VSDs in the low muscular septum (Type IV) is performed through the left ventricle (one patient).