Intracardiac Pressure-Flow Dynamics in Isolated Ventricular Septal Defects

Abstract

This study was conducted to determine the nature of intracardiac shunting in 50 patients between the ages of 3 and 15 years with isolated ventricular septal defects. Simultaneous right and left ventricular pressures and biplane cineangiocardiography were utilized to study the timing and the direction of flow across the defect. Patients with low to moderately elevated right ventricular pressures demonstrated left-to-right shunting across the defect throughout the cardiac cycle. When pressure in the right ventricle approximated that of the left, right-to-left shunting occurred across the defect into the left ventricle during isovolumic relaxation. All patients shared in common the following: (1) a predominant left-to-right gradient and shunt across the defect into the body of the right ventricle during diastole; and, (2) augmentation of the left-to-right gradient with resultant increase of the shunt into the right ventricle during isovolumic contraction immediately preceding opening of the aortic valve. In comparing patients with and without pulmonary hypertension, the major variations in the cardiac cycle occurred during the periods of ventricular ejection and isovolumic relaxation. These two periods are primarily affected by the changing relationships of the size of the defect, ratio of pulmonary to systemic resistance, and magnitude of net shunts.