Handbook of congenital malformations / edited by Alan Rubin.

Date:
1967
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Handbook of congenital malformations / edited by Alan Rubin. Source: Wellcome Collection.

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    VASCULAR RING (continued) Hereditary Factors: Unknown—recurrence rate is about 2 per cent. Treatment and Outlook: Division of the offending great vessel is indicated. Only rarely is grafting necessary, because the involved vessel may be sacrificed in most cases. The prognosis is good. VENTRICULAR SEPTAL DEFECT. Persistent patency of the ventricu¬ lar septum in either muscular or fibrous portions. The opening may be small, resulting in a very loud precordial pansystolic murmur and thrill without symptoms or significant hemodynamic alterations, or it may be huge with, in effect, a common ventricle and no resultant murmur but with marked symptoms and hemodynamic disturbances. Not infrequently, it may be a cause of heart failure in infancy. As many as 25 per cent of ventricular septal defects may close spon¬ taneously in the first few years of life. The diagnosis is easy on clinical examination and is confirmed by cardiac catheterization. Prevalence: The commonest acyanotic congenital heart defect. Associated Anomalies: Ventricular septal defect frequently co¬ exists with pulmonic stenosis, usually of the infundibular type (acy¬ anotic tetralogy of Fallot). It may also be a part of a more complex lesion such as the cyanotic tetralogy of Fallot, tricuspid atresia or transposition of the great vessels in which it is essential for survival. Hereditary Factors: Uncertain—risk of recurrence is about 1 per cent. Treatment and Outlook: Can best be divided into four categories: 1. For the infant with congestive failure, medical treatment usu¬ ally suffices. If not, the pulmonary artery can be banded surgically to reduce pulmonary blood flow. 2. The child or adult with a loud murmur and thrill over the precordium, with no symptoms and normal right heart and pulmonary artery pressures as shown by cardiac catheterization, usually requires no treatment. Subacute bacterial endocarditis occurs in less than 1 per cent of all cases. 3. In the child or adult with an enlarged heart and moderate pulmonary hypertension, with or without symptoms, the defect should be closed by open-heart surgery. 4. The cyanotic patient with a bidirectional shunt due to equal pulmonary and systemic pressures (Eisenmenger complex; see p. 27) is not a candidate for corrective surgery. Pleurectomy, as previously mentioned, may be of palliative benefit. Overall the prognosis for patients with ventricular septal defect is very good. WOLFF-PARKINSON-WHITE SYNDROME (Preexcitation). Acceler¬ ated conduction from the atrium to the ventricle, most likely through the bundle of Kent, short-circuiting the atrioventricular node. Usu¬ ally the syndrome is first manifested long after infancy by episodes 40