The surgical treatment of ventricular septal defect in infancy. The technic and results of pulmonary artery constriction.

IN PATIENTS with ventricular septal defect who are more than 3 or 4 years of age, an open corrective operation may be carried out with minimal risk if the lesion is not complicated by the presence of severe pulmonary hypertension. With surgical technics presently available, however, the closure of a ventricular septal defect in an infant or very young child is associated with considerable hazard. In 41 children under the age of 2 operated upon by Cooley' the mortality was 39 per cent and in Kirklin's experience in 1956, quoted by Keith,2 70 per cent of children in this age group died after open repair. Thus, it seems clear that elective operations for ventricular septal defect should, whenever possible, be deferred until the child has reached optimal age and size. Although isolated ventricular septal defect is generally considered to be one of the more benign congenital cardiovascular malformations, a certain proportion of infants with this lesion develop severe symptomatology and in this group the early mortality is high. Keith, for example, observed a series of 111 symptomatic children with ventricular septal defect; more than one third died in the first year of life.2 Seventeen patients who evideneed heart failure were reported by Morgan et al.3 and, of these, 10 died before the age of 1 year. Marquis4 found that ventricular septal defect was the most common cause of death from congenital heart disease among children less than 3 years of age. It is thus apparent that a large number of infants with ventricular septal defect will tiot survive with nonoperative management and yet should not be subjected to corrective operation because of the prohibitive risk asso-