CONGESTIVE-HEART-FAILURE DURING EARLY INFANCY IN PATIENTS WITH VENTRICULAR SEPTAL-DEFECT RELATIVE TO EARLY CLOSURE

The hemodynamic features of 44 patients requiring surgical closure of a ventricular septal defect (VSD) during early infancy were evaluated. The VSD was closed within the first 6 months of Life in 29 patients ( group A) and during the second 6 months in 15 patients (group B). The left-to-right (GR) shunts were significantly greater in group A than i n group B: although in all patients they were more than 50%. Ln contra st, the left ventricular end-diastolic volume was significantly greate r in group B than in group A, whereas the right ventricular end-diasto lic volume was greater in group A; the difference was not statisticall y significant. The step-up in blood oxygen saturation in the lower rig ht atrium; which was significantly more in group A, indicated the L-R shunt across the patent foramen ovale (PFO). The GR shunt across the V SD during diastole was also detected in all patients angiographically. With early infantile VSD, the larger the L-R shunt the greater was th e likelihood of early surgery, Right ventricular volume overload cause d by the L-R shunt across a PFO as well as through the VSD during dias tole is a useful indicator of a large shunt in infants with VSD.