The Electrocardiogram in Children with Ventricular Septal Defect and Severe Pulmonary Hypertension

Abstract

The height of the pulmonary arterial pressure is in itself of no prognostic importance in determining which patients will have a successful response to surgical closure of a ventricular septal defect. Of prime importance in the selection of patients for this operation is the relationship of the volume of blood flowing through the pulmonary and the systemic circuits. Those patients whose pulmonary blood flow is not in excess of the systemic flow, and who thus have a dominant right-to-left or a balanced shunt, will not experience a reduction in pulmonary arterial pressure after repair. Ecg evidence of increased left ventricular work has proved to be of great value in assessing the pulmonary blood flow, regardless of the presence of severe pulmonary hypertension. Patterns of right ventricular hypertrophy in the ecg usually do not mask evidence of left ventricular over-work when the criteria suggested in this paper are applied, as evidenced by the 99% correlation between ecg evidence of increased left ventricular work and proof of preexisting increased pulmonary flow in the 90 surgically treated patients with ventricular septal defect and severe pulmonary hypertension fulfilling such criteria. On the basis of these observations, it is believed that the ecg has an important role in the selection of such patients for surgical treatment. In the absence of ecg evidence of left ventricular overwork, no patient should be denied surgical intervention if evidence for increased pulmonary flow can be obtained by any other means.