Differential diagnosis of ventricular septal defect in infancy: A common problem

Abstract

An analysis was made of 105 proved cases of congenital cardiac defects in infants under 1 year of age who were seen between 1950 and 1960. Patients were selected who presented with the following clinical findings: (1) a loud or moderately loud systolic murmur maximal in the third and fourth interspaces along the left sternal border; (2) congestive heart failure; (3) absent or minimal cyanosis; and (4) roentgenographic evidence of a large heart with increased pulmonary vasculature. Sixty-five (62%) of the patients selected in this fashion were found to have large ventricular septal defects. This comprised nearly all of the sick infants (65 out of 69) with adequate clinical data and a proved diagnosis of a large ventricular septal defect seen during the 10 year period. Nine different malformations were found to have masqueraded as ventricular septal defects. Two others were added from the literature. The relative frequency of this occurrence is presented. Conversely, the frequency with which the individual defects failed to mimic clinically a ventricular septal defect is analyzed and discussed. The roentgenographic findings were nonspecific, even in retrospect, and were of little aid in all but 3 cases of truncus arteriosus. The electrocardiographic findings, when analyzed with regard to evidence of ventricular hypertrophy or overload, were of value in eliminating possible diagnoses only in cases of aortic stenosis and total aberrant pulmonary venous drainage. Further, the electrocardiographic findings were almost specific in the detection of persistent atrioventricular canal. At the present time it appears necessary to perform cardiac investigative studies (cardiac catheterization and angiocardiography) in a majority of infants who present with this syndrome in order to determine the diagnosis and proper treatment.