Retrograde left ventricular angiocardiography in ventricular septal defect

Thirty-five patients with ventricular septal defect underwent selective left ventricular angiocardiography in addition to selective venous angiocardiography, cardiac catheterization and routine laboratory studies. In 30 of these the ventricular septal defect was uncomplicated; in 5 it was accompanied by other anomalies although the ventricular septal defect was still the predominant lesion. The angiocardiograms demonstrated shunting of the contrast material into the right ventricle in all patients. Based on the level of the shunt stream, the defects were classified as membranous (21 cases), high muscular (9 cases) and low muscular (4 cases). In one additional case there were two defects, one in the pars membranacea and another in the apical portion of the muscular septum. The shunt-streams were distinct in the majority of cases and enabled estimation of their circular area at their point of origin from the septum. These were assumed to represent the actual size of the defect. Contraction of the ventricular septal defect, manifested by changing diameters of the shunt-stream during various phases of the cardiac cycle, was noted in nearly half of the membranous defects; it was most conspicuous in muscular defects. In 7 patients routine cardiac catheterization failed to reveal a left-to-right shunt although in 3 of these, selective dye-indicator studies revealed small left-to-right shunts. These findings suggest that left ventricular angiocardiography is superior to routine cardiac catherization for demonstrating the presence of a tiny ventricular septal defect. There were no complications encountered in the present series. Our studies indicate that selective left ventricular angiocardiography is useful for indicating the presence, location, size and number of ventricular septal defects, and the existence of any associated intracardiac anomaly of the left side.