Abstract
The persistence of signs of obstructive lung disease in some infants with VSD and left to right shunt, despite apparent cardiac compensation, suggests underlying or unrelated lung disease. To determine whether the chronic lung hyperinflation and respiratory acidosis seen in these infants is reversible, we analyzed the course of nine infants who presented at 1 month to 7 months of age. All had wheezing and persistent x-ray evidence of hyperinflation, either generalized or lobar, and five had chronic hypercarbia. The increase in heart size and pulmonary vascularity varied from mild to severe; pulmonary to systemic blood flow ratios ranged from 1.8 to 4.1/1, and pulmonary to systemic mean arterial pressure ratios ranged from 0.3 to 0.9. There was no relationship between the severity of cardiac disease and the manifestation of obstructive lung disease. Both chest x-ray and arterial blood gas findings reverted to normal in all of the patients following open heart correction of the VSD at 4 to 12 months of age. We conclude that the chronic obstructive lung disease in infants with VSD and left to right shunt is directly related to the cardiac disease and is completely reversible when the heart lesion is surgically corrected.
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