Now that ventricular septal defect is amenable to surgical repair it is most important to define the indications for surgical intervention. In this paper the natural history of the disease and its clinical and physiologic characteristics are carefully detailed. These observations permit better recognition and understanding of the condition and offer a basis for comparison with results after surgery.IT HAS BEEN demonstrated recently that ventricular septal defects in children can be repaired surgically with an acceptable mortality rate under appropriate circumstances.1-3 For infants who at present are not considered suitable candidates for direct surgical repair, an ingenious palliative operation offers considerable theoretical promise. To achieve a better understanding of the nature of the anomaly and to arrive at some working hypothesis ill regard to operative indications, we reviewed the clinical picture, the physiologic data, and the natural history of our patients with proven ventricular septal defect.
MATERIALS AND METHODSThe physiological data were surveyed on all patients admitted to the Children's Medical Center, Boston, between 1950 and and diagnosed at cardiac catheterization as having a ventricular septal defect. All these subjects had an increase in oxygen content of at least a 1.0 volume per cent at the right ventricular level as compared to the right atrial sample. The catheterized patients were considered to have severe disease on clinical grounds; thus they represent a select group from the total number of children with ventricular septal defect attending our clinic.The catheterization data were reviewed for completeness and all patients with associated cardiac anomalies other than pulmonary stenosis or aortic regurgitation were arbitrarily excluded. Cases of ventricular septal defect and pulmonary stenosis with a resting arterial saturation of less than 94 per cent were also eliminated as examples Fromt the ShliArol Caar(liovalscular
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