Influence of left ventricular cavity size on interventricular shunt timingand outcome in neonates with coarctation of the aorta and ventricular septal defect

Currently, coarctation of the aorta can be repaired with low morbidity and mortality in neonates.(1,2) Approximately 40% of patients with coarctation have an associated ventricular septal defect (VSD) that typically shunts fr om left-to-right during systole, influencing hemodynamics, clinical present ation, and treatment. Neonates with coarctation and VSD usually have pulmon ary hypertension(3-8) and decreased left ventricular (LV) distensibility(3) that may influence the amount and direction of shunting at the ventricular level. This study examines VSD shunting patterns, identifies anatomic feat ures associated with each pattern, and evaluates the influence of these fea tures on outcome of patients with coarctation and VSD.