Atrial septal defect: acute left heart failure after surgical closure.

Sixteen of 766 patients operated on for isolated arterial septal defect developed severe acute left heart failure that necessitated partial reopening of the defect; 6 died. The prognosis depended mainly on prompt surgical intervention. The most frequent pathological and anatomical finding was marked hypoplasia of the left ventricle. Pulmonary hypertension appeared to be of minor importance. Hemodynamic data published by others support the hypothesis that this complication is often the result of markedly impaired left ventricular compliance associated with left ventricular hypoplasia.