Surgical experience of closure of ventricular septal defect with special reference to the transatrial approach.

One hundred patients underwent closure of ventricular septal defect (VSD) during the years 1964-1977. The right transventricular approach was used in 92, the left ventricular in one, the pulmonary artery in one and the transatrial in the remaining 18 patients. Six patients (5.3%) died following operation. All of them suffered from severe pulmonary vascular resistance. Six patients have been reoperated successfully because of residual shunt. The transatrial approach is being used at present as a routine for closure of types II and III of VSD, particularly in patients with pulmonary vascular resistance. All the surviving 106 patients are in class one and two of the NYHA. At present, closure of VSD in asymptomatic patients is being performed electively at the ages of three to five, whereas symptomatic children, with high pulmonary vascular resistance and heart failure not responding to medical treatment, are operated on early in life usually with the use of deep hypothermic arrest.