Optimal timing of surgery in common left to right shunts.

Left to right shunts like atrial septal defect, ventricular septal defect and patent ducts arteriosus are commonly encountered congenital malformations of the heart. With advances in diagnostic and therapeutic technology over the last three decades the recognition and management of these lesions has markedly improved. Currently, the surgical procedures are being performed in infants and neonates with the hope that long term results would be better. Children with atrial septal defects are usually asymptomatic or mildly symptomatic and closure of the defect is best performed at 3-4 years of age. Large ventricular septal defects, on the other hand, may produce symptoms like congestive heart failure in early infancy and early closure is recommended for these babies. These defects are also known to close spontaneously and therefore in mildly symptomatic cases without pulmonary arterial hypertension, one may wait for a natural reduction in size. Surgical ligation of a patent ductus arteriosus is a safe and simple procedure and all these cases must undergo closure of the duct.