Surgical indication and results in ventricular septal defect associated with severe pulmonary hypertension

Sixty-four patients with large ventricular septal defects and severe pulmonary hypertension form the basis of this report. Prior to the end of 1970, 35 patients with a ratio of pulmonary to systemic artery pressure (pp/ps) of 0.8 or more were subjected to primary closure of the defect, resulting in 11 operative deaths Since the beginning of 1971, until March, 1974, however, the surgical results have markedly improved and 29 such patients were operated on without death. It has been our principle to perform elective closure of the defect at the age of 1 to 3 years. An earlier operation was planned when a decrease in the apical diastolic rumble and the size of the enlarged left ventricle on the chest x-ray were found on the periodical observation since infancey. If cardiac failure could not be controlled with medical treatment, primary closure of the defect has been performed even under one year of age.