Spontaneous Closure of Ventricular Septal Defect

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Abstract
A 27-year-old man, had had cyanosis, clubbing, and a precordial murmur since infancy. At the age of 17 a left subclavian-pulmonary arterial anastomosis was performed at another hospital. His physical activity became progressively limited despite this. On examination there was marked clubbing of the fingers and toes. The heart was enlarged. The second sound at the base was single, and a grade II/VI ejection-type systolic murmur and a faint continuous mur-mur were heard at the upper left sternal border. The ecg revealed left ventricular hypertrophy, left axis deviation, left atrial enlargement, and abnormal initial forces indicative of an old anteroseptal myocardial infarct. Fluoroscopic and radiographic examinations disclosed enlargement of the left ventricle and hypoplasia of the pulmonary arterial segment. The hematocrit value was 82%. At right heart catheterization the catheter passed across an interatrial communication into the left atrium and then into a ventricular chamber, where a pressure of 116/12 mm. Hg and an oxygen saturation of 83% were recorded. Simulteneously, the systemic arterial pressure was 112/66 mm, Hg and systemic arterial oxygen saturation was 88%. Neither the pulmonary artery nor the right ventricle was entered by the catheter. Indicator-dilution curves indicated a large right-to-left shunt at the atrial level. A selective angiocardiogram with right atrial injection confirmed the clinical diagnosis of tricuspid atresia. At operation an anastomosis was created between the distal end of the right pulmonary artery and the proximal end of the superior vena cava. The procedure was complicated by the prescence of an extensive collateral circulation between the lung and chest wall, and the patient died in the early post-operative period of massive and uncontrollable bleeding into the pleural space.

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