Ventricular septal defect is the most common congenital heart disease. It has a wide linical spectrum which depends on the size of the defect, the amount of shunt and the degree of resistance of the pulmonary circulation, The electrocardiogram has proved a useful tool in estimating the severity of the hemodynamic factors in any individual case.
This series comprises 62 patients in whom the clinical diagnosis of isolated ventricular septal defect was confirmed by right heart catheterization at Severance Hospital during the past 9I years. An attempt is made to correate the electrocardiographic findings with the hemodynamic data in these cases.
1. Of the 62 patients, 29 were male and 33 were female. Their ages ranged from 3 months to 37 years the mean age was 10.5 years.
2. The children (below 15 years of age) had the variable distribution of pulmonary to systemic flow ratio (Qp/Qs) and pulmonary artery systolic pressure (PASP). Most of the adults) (above 15 years of age) had the Qp/Qs of 2.0 or less. Six of 18 adults had the normal PASP and the others had marked pulmonary hypertension. There was no age correlation for the pulmonary vascular resistance (PVR).
3. Eighty per cent of the cases had the pulmonary hypertension. There was 7 cases with Eisenmenger Syndrome in 21 cases with severe pulmonary hypertension (PASP>70 mm. Hg).
4. Four cases were recatheterized one to six years later. One patient with severe pulmonary hypertension showed persistence of the pulmonary hypertension after repair of the defect. In another, the pulmonary artery pressure fell markedly due to infundibular stenosis.
5. Spontaneous closure of ventricular septal defect occurred in a 20 year-old male 6 years after the first cardiac catheterization.
6. The :Katz-Wachtel phenomenon of large diphasic QRS complex in precordial leads was e countered in 46.5 per cent of the cases.
7. When the R:S ratio in V1 was more than 1.0, the right ventricular systolic was signif cantly higher than when the R:S ratio was less than 1.0 (p8. Normal electrocardiographic patterns appeared in 38 per cent of the cases, left ventricula hypertrophy and biventricular hypertropy in 22 per cent respectively, and right ventricular by p ertrophy in 18 per cent.
9. When a normal electrocardiographic pattern was present, the PASP and PVR wer: normal and the left to right shunt was invariably relatively low. When left ventricular hypertrophy was present, the PVR was not high and the shunt was fairly large. There was a considerable diastolic volume overload to the left ventricle. When biventricular hypertrophy was present, the PASP and PVR were high and-a-large shunt was present, and there was diastolic volume overlo d to the left ventricle and systolic pressure overload to the right ventricle. When right ventricular hypertropy was present, the PASP and PVR were almost invariably at systemic level The shunt Iwas n,- t large and three of ten cases had reversal of flow.
In isolated ventricular septal defect the electrocardiographic findings has the significant correlation with the hemodynamic data. The electrocardiogram may help to indicate the severity of ventricular septal defect.
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