Corrective treatment of isolated ventricular septal defect in infancy.

Intracardiac correction of VSD in infants should be indicated if the mortality and morbidity of the operation at this age group is lower than cumulative mortality of pulmonary artery banding plus second-staged procedure mortality. Experience with closure of VSD in 23 patients under 1 yr of age with 4% mortality and low morbidity is presented. Indications for operation are: (1) intractable heart failure; (2) persistence or progression of pulmonary hypertension; and (3) failure of banding procedure. Deep hypothermia and circulatory arrest facilitated the intracardiac repair in all patients. Mortality and morbidity related to the banding procedure are emphasized, and it is suggested that banding be restricted only to patients with associated coarctation of the aorta or to patients with multiple muscular ventricular septal defects in whom left ventriculotomy can be safely performed at an older age.