Selection for surgery of patients with ventricular septal defect and pulmonary hypertension.

Estimation of pulmonary blood flow relative to systemic blood flow is a critical point in selecting patients with ventricular septal defect and severe pulmonary hypertension for operation. A detailed medical history, physical examination, thoracic roentgenograms, careful interpretation of electrocardiograms, cardiac catheterization, and biopsy of the lung provide approaches to the problem. In borderline cases, decision still may.' be extremely difficult. The authors usually favor operation, however, with recognition that this decision may be in error. Obviously proper evaluation for operation cannot