The operative closure of ventricular septal defects in childhood.

Incidence and Natural History Ventricular septal defect is the commonest congenital heart lesion in childhood and probably accounts for 20% of all heart defects (Keith, Rowe, and Vlad, I958). It has been reported to be the second most common cause of death in children suffering from heart disease (Zacharioudakis, Terplan and Lambert, 1957). An accurate appraisal of the life-span of a child born with a ventricular septal defect is difficult to secure. Death in the first year of life from an isolated ventricular septal defect is not uncommon. If an infant survives the first year of life without developing heart failure, or with proper medical management of heart failure, life expectancy should depend upon the size of the defect, the volume of flow through it and the pulmonary resistance. As pulmonary vascular resistance increases, the volume of shunt diminishes and the child may lead a relatively asymptomatic life until such a time as the shunt becomes bi-directional or from right to left and the patient succumbs in early adult life. In a series of 98 catheter-proven ventricular septal defects in children, Fyler, Rudolph, Wittenborg and Nadas (I958) found only one death after infancy. There were five deaths in infancy in this study.