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We describe the results of surgical repair of atrial septal defects in 36 children who did not undergo pre-op cardiac catheterization. These cases were seen at the Hospital de Cardiologia y Neumología Dr. Luis Méndez del Centro Médico Nacional. There were 24 (67%) females and twelve (33%) males. The mean age was 6.4 +/- 2.4 years with a range from three to thirteen. All cases had auscultatory findings typical of atrial septal defect. Five patients with associated tricuspid murmur (chest film showed grade I cardiomegaly in 21 (58.3 per cent), grade II cardiomegaly in fifteen (41.7 percent). Pulmonary artery shadow was normal in 24 (66.6 percent) and increased in twelve (33.3%). Pulmonary blood flow was increased in all of them. Electrocardiogram showed sinus rhythm in 35 (97.2%). In one instance left atrial rhythm; all EKGs demonstrated right axis deviation, complete right bundle branch block and right ventricular hypertrophy with diastolic overload. Only three had right atrial hypertrophy. The M-mode echocardiogram showed right ventricular dilatation in all and paradoxically septal motion in 26 (72.2%). Two-dimensional echo with the subxiphoid view allowed direct visualization of the defect in all cases. We performed contrast echocardiogram in eight cases and Doppler echocardiogram in six of them. Cardiac surgery findings were ostium secundum atrial septal defect in 34 (94.4%). Two of them also had partial anomalous venous connection. All had uneventful recovery. We conclude that in typical atrial septal defects operative repair is feasible without prior cardiac catheterization.

The association of coarctation of the aorta (CoAo) and ventricular septal defect (VSD) reaches a high mortality rate of approximately 75% in the first year of life without surgical treatment. We present our experience in the study of twenty cases with this combination of congenital heart defects with ages varying from 5 days to 13 years; half of them were under 6 months of age: there was a slight female predominance. Congestive heart failure was the first clinical manifestation in 75% of the patients; all of them showed clinical evidence of VSD with pulmonary hypertension. Twelve patients were surgically treated; in five, a subclavia flap technic was used; in another five, a rhomboid patch was placed at the site of CoAo and in the remaining two, the repair was done by end to end anastomosis. Banding of the pulmonary artery was performed in two cases and both survived; in three cases, in which the CoAo and VSD repair was done simultaneously, only one survived. We have an overall surgical mortality of 25%. Due to the short follow-up we have been unable to determine which cases may require reoperation later in life.