Trans-pulmonary arterial closure of ventricular septal defect.

Fourteen patients ranging in age from 4 months to 28 years underwent closure of a ventricular septal defect (VSD) through the pulmonary valve after pulmonary arteriotomy. In 13 of these the VSD was of the supracristal type and in one patient it was of the bulboventricular type. In all patients, including two infants whose VSD was closed under circulatory arrest, the operative and postoperative courses were uneventful except in one, who needed prolonged respiratory care. Right bundle branch block (RBBB) resulted in four patients, one of whom had a bulboventricular defect. The procedure is technically feasible without difficulty when the VSD is of the supracristal type and when the patient is too small. Trans-pulmonary arterial closure is the method of choice for treating a supracristal VSD, as this procedure leaves no postoperative right ventricular scar. However, the advisability of continuing to use this procedure is to be decided after statistical analysis of the frequency of postoperative RBBB can be made with a larger series of patients.