A rational approach to the treatment of isolated ventricular septal defect depends on the understanding of the natural course of this malformation and an appreciation of the wide variations of hemodynamic responses associated with this defect. The spectrum of the natural course of ventricular septal defect includes the following categories: (1) death from heart failure and pulmonary hypertension in infancy, (2) death from pulmonary hypertension in adult life, (3) the development of right ventricular outflow stenosis, (4) morbidity, especially in infancy and childhood related to pulmonary infections and increased pulmonary blood flow with or without pulmonary hypertension, (5) development of subacute bacterial endocarditis, (6) spontaneous closure of the defect, and (7) a large group of asymptomatic patients. In an attempt to evaluate the course of patients in the above categories and their interrelationship to each other, 400 patients with ventricular septal defect were studied.
Material and Methods
All of the