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Clinical and physiologic sequelae of large ventricular septal defects

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      Abstract

      The clinical and hemodynamic data in twenty-nine patients with large ventricular septal defects are analyzed. Evidence of heart failure is uncommon in those with pulmonary vascular disease and/or pulmonic stenosis alone, in contrast to those in whom certain other additional congenital lesions are present. These data are analyzed in terms of a physiologically single ventricle which exists when a large ventricular septal defect is present. Obligatory beat to beat synchronicity of the right ventricular and systemic arterial systolic pressure is discussed and its use in the diagnosis of the physiologically single ventricle in man outlined. Evidence is presented that in the face of a physiologically single ventricle, ventricular failure is most likely to occur when a volume or flow load is present in addition to right ventricular hypertension. The evolution and hemodynamic recognition of ventricular failure in the face of a physiologically single ventricle is discussed.
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