Ventricular septal defect: selection of patients and timing for surgery

Eighty-seven patients with isolated ventricular septal defect (VSD) operated on in the first 5 years of life, that had a mean interval of 10 months between diagnostic catheterization and surgery, were studied retrospectively. The size of the VSD was correlated with diagnostic catheterization data and comparative analysis of clinicl findings (ECG and CTR) was made between the time of diagnostic catheterization and just prior to surgery. The study showed that 42 per cent of patients with the ratio of systolic pulmonary artery pressure to systolic systemic artery pressure (Pp/Ps) 0.5 to 0.8 had a marked reduction in size of VSD in a rather short interval of 10 months. In patients with Pp/Ps greater than or equal to 0.8, the incidence of decrease in VSD size was close to nil. The highest incidence of decrease in VSD size was seen in patients with high flow and low resistance. ECG and CTR were very useful diagnostic tools to follow the course of the VSD size. The patients with Pp/Ps 0.5 to 0.8 should be observed for an interval of 10 to 12 months, expecting spontaneous decrease in VSD size. If clinical parameters (ECG, CTR) fail to improve in that interval, then the patients should have surgery. The patients with Pp/Ps greater than or equal to 0.8 should be operated on without delay.