Eisenmenger's complex; a clinical and pathologic study of four cases

Spontaneous closure of physiologically advantageous ventricular septal defects

The clinical and pathological features of two cases in which physiologically advantageous ventricular septal defects closed spontaneously are presented. The first patient, with tricuspid atresia, Type I(c), developed symptoms and signs of increasing systemic hypoxemia, decreasing pulmonary blood flow, and a systolic murmur of decreasing intensity. His ventricular septal defect, previously demonstrated angiocardiographically, could not be found at autopsy; it is presumed to have closed by fusion of its muscular rims with subsequent covering by endocardial proliferation. The second patient, with a double-outlet right ventricle, demonstrated progressive left ventricular enlargement and congestive failure despite increasing pulmonary vascular resistance. Postmortem examination showed that this defect was sealed by adherence of the septal leaflet of the tricuspid valve to the edges of the defect. Appreciation of the true nature of the changing anatomical situation would have resulted in more rational effective therapeutic approaches.

The cases presented and review of pertinent literature contribute to more complete understanding of circumstances surrounding the spontaneous closure of ventricular septal defects.

Right-sided aorta. I. Occurrence of right aortic arch in various types of congenital heart disease. II. Right aortic arch, right descending aorta, and associated anomalies

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The Natural History of Ventricular Septal Defect in Patients Surviving Infancy

It is now possible to synthesize the natural history of ventricular septal defect. Size is fundamental, and stemming from it, the smaller defects (groups 1 and 2) separate from the larger (groups 3, 4, and 5) immediately at birth. Apparent size may differ from real size, for defects may become partially closed by tricuspid valve leaflets, or be gradually obstructed by an enlarging aneurysm of the sinus of Valsalva. One instance has been observed in which a muscular defect was obstructed by a large papillary muscle. The reverse may also occur, i.e., a partially obstructed defect may enlarge as a blocking tricuspid leaflet detaches or tears.