Congenital Aortopulmonary Septal Defect

The clinical, hemodynamic, and angiographic findings in six patients with aortopulmonary septal defect are described. A basal systolic murmur was present in each of the patients and in none was a continuous murmur audible or recordable. Five of the patients had experienced diminished cardiac reserve and at right heart catheterization a large left-to-right shunt and severe pulmonary hypertension were found. In the sixth patient the predominant circulatory shunt was right-to-left. The diagnosis was established preoperatively in all patients with the aid of indicator-dilution curves, injections of Kr85 and selective angiography. The defect was successfully divided and closed at open operation in the five patients with predominant left-to-right shunts. Two of them were operated upon with the aid of general hypothermia and three with cardiopulmonary bypass. Postoperatively all patients have been improved and the pulmonary artery pressure has fallen markedly. The clinical picture, hemodynamic findings, and surgical results in 65 previously reported patients are also summarized.