Correlation of chest roentgenograms and hemodynamic findings following surgical repair of ventricular septal defects.

Abstract

The diagnosis and hemodynamic evaluation of ventricular septal defect are made at cardiac catheterization. The present-day value of the plain chest roentgenogram, then, is in following the evolution of the defect, and it has proved especially useful in detecting Eisenmenger's reaction and its associated pulmonary hypertension. Little emphasis, however, has been placed on the changes seen following surgical closure of the defect. This study was undertaken to determine the roentgen changes in the chest following successful closure of the ventricular septal defects and the rate at which such changes evolve. Materials and Methods The chest films and catheterization data of all patients operated upon for the repair of uncomplicated ventricular septal defects from January 1959 to December 1965 and in whom preoperative and postoperative cardiac catheterizations were performed were analyzed independently. Patients with residual postoperative shunts were included in the original analysis, and the person evaluating the films was unaware of the catheterization data. Patients with residual shunts were subsequently excluded from the series. Plain chest roentgenograms, including barium swallows in all cases, were evaluated for the degree of cardiac chamber enlargement, the extent of main pulmonary artery enlargement, and the degree of pulmonary vascularity. Left atrial and main pulmonary artery size and peripheral pulmonary vasculature were judged as normal, slightly increased (1+), moderately increased (2+), or greatly increased (3+), using established criteria (1–4, 10, 15, 16). All available follow-up films up to one year after surgery were examined. Catheterization data utilized included the pulmonary artery pressure, the ratio of pulmonary-to-systemic flow (the degree of left-to-right shunting), and the ratio of pulmonary vascular resistance to systemic vascular resistance (8, 9). A ratio of pulmonary-to-systemic flow of less than 2:1 was considered to be a moderate left-to-right shunt, and those ratios greater than 2:1 were considered to indicate large shunts. Pulmonary vascular resistance less than 0.25 was considered normal, from 0.26 to 0.50 moderately elevated, and greater than 0.50 markedly elevated. There were 61 patients in the original analysis, with ages ranging from three to forty-eight years. Forty-nine showed no evidence of residual shunting at the time of postoperative cardiac catheterization, and the age distribution for the final group is as follows: one to five years, 13 patients; six to ten years, 14 patients; eleven to twenty years, 12 patients; twenty-one to thirty years, 6 patients; thirty-one to forty years, 2 patients, and forty-one years or more, 2 patients.