Ventricular septal defect and left sided obstructive lesions in infants.

Infants born with ventricular septal defect and left sided obstructive lesions display a variety of pathophysiologic features. Some patients have relatively straightforward afterload- or preload-induced congestive heart failure, whereas others have a mixed pattern. The presence of patent ductus arteriosus may add to the left-to-right shunt, or when the physiology is that of preductal coarctation, may be associated with a small left ventricular chamber. Over the years, various management schemes have been devised for infants with ventricular septal defect and left sided obstructive lesions. These have continued to evolve as surgical skills and techniques have improved for the neonate. However, differences among medical centers remain in 1994 regarding the type and timing of various one- and two-stage repairs. Ventricular septal defect and coarctation or interrupted aortic arch, especially when associated with other types of left ventricular outflow obstruction remains a serious high-risk problem, but affected infants appear to have a better long-term prognosis today than in the past. Complete repair at the time of diagnosis in the neonate, regardless of whether associated obstructions are present, remains the gold standard. However, excellent results can be obtained by more conservative approaches to these lesions, especially if the ventricular septal defect is not unduly large. For patients with ventricular septal defect and mitral stenosis, a series of palliative procedures and operations are often required.