Experience with congenital defects of the interventricular septum has shown that the prognosis is poor if the defect and associated shunt flow are large, both ventricles are enlarged, and the pressures in right ventricle and pulmonary artery are elevated. The pressures found by catheterization are an important criterion of operability. Direct-vision closure of ventricular septal defects was carried out by means of a pump-oxygenator in 22 cases. There has been no operative mortality among the 16 patients whose right ventricular pressures had been below 80 mm. Hg The six patients who died had an average right ventricular pressure of 95.6 mm. Hg. The best time for closure is when there still is a large left-to-right shunt, with the electrocardiogram showing evidence of diastolic overloading of the left ventricle. Operations correctly timed, in patients with low right ventricular pressures, carry the minimum risk.
Kay EB, Sambhi MP, Nogueira C, Zimmerman HA. TREATMENT OF VENTRICULAR SEPTAL DEFECTS. JAMA. 1957;165(17):2168–2174. doi:10.1001/jama.1957.02980350026006
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