THE provocative paper by Sigmann, et al. in this issue is an excellent exposé of the activist point of view in pediatric cardiology. One cannot but congratulate the authors on their diagnostic and surgical skills. Still, being a reluctantly adopted citizen of conservative New England, this member of the Editorial Board feels called upon to present a critique of the Ann Arbor publication and to propose an alternate, more restrained, approach to treatment of infants with ventricular septal defect. First, we ought to compare the mortality rates of Doctor Sigmann's patients who were operated on, if possible, with those they treated medically themselves and with those so managed elsewhere.