Abstract We have reviewed the electrocardiograms of 100 children with isolated ventricular septal defect for (1) possible typical or diagnostic patterns, (2) relationship to pulmonary artery pressure and flow and to histological pulmonary vascular changes, and (3) prognostic significance as to surgical risks. Descriptions regarding the electrocardiogram in patients with ventricular septal defect have been varied. Taussig1 considered the electrocardiogram to be of little diagnostic aid in ventricular septal defects. She noted that bizarre ventricular complexes of high amplitude were often associated with this defect but stated that similar findings occurred with equal frequency in other heart malformations. Others have reported that the electrocardiogram varies with the clinical picture, depending upon the size of the septal defect, location of the defect, and the pulmonary peripheral resistance. Kjellberg et al.,2 in reviewing their 45 cases with this defect, noted that when the pulmonary and systemic arterial pressures were balanced the References 1. Taussig, H. B.: Congenital Malformations of the Heart , New York, Commonwealth Fund, Cambridge, Mass., Harvard University Press, 1947. 2. Kjellberg, S. R.; Mannheimer, E.; Rhude, U., and Jonsson, B.: Diagnosis of Congenital Heart Disease , Chicago, The Year Book Publishers, Inc., 1955. 3. Nadas, A. S.: Pediatric Cardiology , Philadelphia, W. B. Saunders Company, 1957. 4. Marsico, F.; Penaloza, D.; Tranchesi, J.; Limon, R., and Sodi-Pallares, D.: The Electrocardiogram in Interventricular Septal Defect: Scalar and Vectoral Analysis of 32 Cases , Am. Heart J. 49:188 ( (Feb.) ) 1955.Crossref 5. Sodi-Pallares, D.: New Bases of Electrocardiography , St. Louis, The C. V. Mosby Company, 1956. 6. Katz, L. N., and Wachtel, H.: The Diphasic QRS Type of Electrocardiogram in Congenital Heart Disease , Am. Heart J. 13:202 ( (Feb.) ) 1937.Crossref 7. DuShane, J. W.; Kirklin, J. W.; Patrick, R. T.; Donald, D. E.; Terry, H. R., Jr.; Burchell, H. B., and Wood, E. H.: Ventricular Septal Defects with Pulmonary Hypertension: Surgical Treatment by Means of a Mechanical Pump-Oxygenator , J.A.M.A. 160:950 ( (March 17) ) 1956.Crossref 8. Agustsson, M. H.; DuShane, J. W., and Swan, H. J. C.: Ventricular Septal Defects in Infancy and Childhood , Pediatrics 20:848 ( (Nov.) ) 1957. 9. Hubbard, T. F., and Angle, W. D.: The Electrocardiogram in Ventricular Septal Defect: A Correlative Study of 50 Cases , A. M. A. J. Dis. Child. 94:20 ( (July) ) 1957.Crossref 10. Mannheimer, E.; Ikkos, D., and Jonsson, B.: Prognosis of Isolated Ventricular Septal Defects , Brit. Heart J. 19:333 ( (July) ) 1957.Crossref 11. Zacharioudakis, S. C.; Terplan, K., and Lambert, E. C.: Ventricular Septal Defects in the Infant Age Group , Circulation 16:374 ( (Sept.) ) 1957.Crossref 12. Dreifuss, L.; Bender, S.; Bentvoglio, L.; Downing, D., and Goldberg, H.: Significance of Right Heart Strain in 400 Cases of Congenital Heart Disease, Hemodynamic and Electrocardiographic Correlation , Circulation 16:873 ( (Nov.) ) 1957. 13. Zimmerman, H. A.; Kay, E. B.; MacKrell, J., and Sambhi, M. P.: Indications and Contraindications for Open Cardiac Surgery , Am. Heart J. 54:727 ( (Nov.) ) 1957.Crossref 14. Kay, E. B.; Sambhi, M. P.; Nogueira, C., and Zimmerman, H. A.: Treatment of Ventricular Septal Defects , J.A.M.A. 165:2168 ( (Dec. 28) ) 1957.Crossref 15. Burchell, H. B.: Clinical Problems Related to Surgical Repair of Intracardiac Defects with the Aid of an Extracorporeal Pump-Oxygenator , Circulation 16:976 ( (Dec.) ) 1957.Crossref 16. Adams, P., Jr.; Lucas, R. V., Jr.; Ferguson, J. D., and Lillehei, C. W.: Significance of Pulmonary Pathology in Interventricular Septal Defect, to be published. 17. Ziegler, R. F.: Electrocardiographic Studies in Normal Infants and Children , Springfield, Ill., Charles C Thomas, Publisher, 1951. 18. Cabrera, E., and Monroy, J. R.: Systolic and Diastolic Loading of the Heart , Am. Heart J. 43:661; 669 ( (May) ) 1952.Crossref 19. Sodi-Pallares, D., and Marsico, F.: The Importance of Electrocardiographic Patterns in Congenital Heart Disease , Am. Heart J. 49:202 ( (Feb.) ) 1955.Crossref 20. Grant, R. P.; Sanders, R. J.; Morrow, A. G., and Braunwald, E.: Symposium on Diagnostic Methods in the Study of Left-to-Right Shunts , Circulation 16:791 ( (Nov.) ) 1957.Crossref 21. Blount, S. G.; Balchum, O. J., and Gensini, G.: Persistent Ostium Primum Atrial Septal Defect , Circulation 13:499 ( (April) ) 1956.Crossref 22. Kiely, B.; Adams, P., Jr.; Anderson, R. C., and Lester, R. G.: The Ostium Primum Syndrome , A.M.A. J. Dis. Child. 96:???. 23. Anderson, R. C.; Lillehei, C. W., and Lester, R. G.: Corrected Transposition of the Great Vessels , Pediatrics 20:626 ( (Oct.) ) 1957.
A.M.A. Journal of Diseases of Children – American Medical Association
Published: Jan 1, 1959