Surgery of ventricular septal defects.

Direct surgical repair of most defects within the heart has become almost a mundane occurrence. Its rapid growth to maturity has been fostered by many pioneers, of whom we acknowledge Alfred Blalock, Sir Russell Brock, John Gibbon, and Walton Lillehei. These are just a few of the dynamic leaders among hundreds who by faith, hard work, and research have created the method of intracardiac surgery utilizing extracorporeal circulation and cardio-pulmonary bypass. Although the prognosis for small septal defects is excellent and the disability trivial, there is general agree ment that, if the shunt is significant, survival into adult life is unusual. Death occurs from heart failure, endocarditis, or respiratory complications. Heart failure is due to an excessive mechanical work load imposed on the heart by the shunt itself or by progressive endarteritic obstruction of the pulmonary arterial fields in response to hypertension. There is a wide variation in pulmonary arterial resistance from case to case. In most cases ventricular septal defects are amenable to surgical closure and cure. The risk involved varies with the type and severity of the disease and the surgical skills available.