[Late results of the surgical treatment of interventricular septal defects]

The work deals with the following three problems: the criteria for the appraisal of the remote results; the evolution of pulmonary hypertension following correction of the defect; the indications for a repeated operation in reshunting. The examination was conducted on a group of 132 patients in postoperative periods of up to 13 years (5 years on the average) who had undergon surgery at the age of over 3 years. The analysis shows that the findings of clinical, electro-, phonocardiographic and X-ray examination are only of auxilliary importance as the criteria for the evaluation of the remote results. Changes in hemodynamics in remote periods after closure of the defect are the main indices of the efficacy of surgical management of patients with high pulmonary hypertension; it is just these changes that determine the prognosis. Considerable improvement in hemodynamics is revealed in most patients, which attests to the efficacy of surgery. In 29.2% of patients of the older age groups, however, mild or severe affection of the vessels of the pulmonary circulation was discovered. These data are an important argument in favour of early radical correction of the defect. In partial reshunting on the background of considerable improvement in hemodynamics and the general condition of the patient, one may refrain from carrying out an operation again and continue dynamik observation of the patient.