Medical problems in correction of ventricular septal defects

Abstract

The medical problems in surgical correction of VSD begin with establishing the need for and feasibility of the operation. Consideration for surgery involves determining which of the 6 physiologic types is present in an individual case both from a clinical and hemodynamic standpoint and which of the 7 or more anatomic varieties the patient is likely to have. In addition, anomalies which pose as VSD must be eliminated by definitive study. Medical considerations further involve the preparation of the patient physiologically and psychically for the operation, familiarity with the progress of the actual surgical procedure and above all, intense involvement along with the surgeon and anesthesiologist in the care of the patient after his return to the recovery room, especially in the first 12 to 24 hours. The cardiologist is obligated to estimate the success of the VSD closure and the guide the patient toward full rehabilitation. He ultimately must release the patient from “medical bondage” once he is assured by postoperative physiologic studies that the altered dynamics have been corrected. Longitudinal follow-up examination to add to our knowledge is permissible and desirable but this investigative interest should be frankly explained to the patient to prevent any anxious misunderstanding about our motive for the examinations.