The Appraisal of Cardiovascular Status In Infancy By Physical Examination

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ADVANCES in cardiovascular surgery have stimulated interest in the prompt appraisal of the functional significance of congenital cardiovascular defects. The demand for precise anatomic diagnosis has led to the utilization of complex diagnostic methods, such as cardiac catheterization, angiocardiography, fluoroscopy, respiratory gas analysis, and simultaneous precordial lead electrocardiography. Initially, however, recognition of the presence of an anomaly, estimation of its functional importance, and an attempt at accurate localization depends on the patient’s history and physical examination. This can be accomplished with some degree of exactness in the case of the more common defects encountered in childhood and adult life. In infancy evaluation of the findings on physical examination has been less well defined, and a correct anatomic diagnosis rarely is established on this basis alone.

The highest mortality rate in congenital heart disease occurs in infancy. One reason for this is that certain defects are so severe as to be incompatible with extra-uterine life. Nevertheless a significant number of deaths occur in infants having anomalies which are either relatively benign, when encountered in older age groups, or are amenable to surgery. In a series of 110 postmortem examinations on children with congenital heart disease who died before the third year of life, Marquis1 noted that 25 per cent of the total group had ventricular septal defects. Deaths due to severe tetralogy of Fallot or to uncomplicated patent ductus arteriosus in the first year of life are not uncommon.

If the mortality and morbidity of congenital heart disease in infants is. . .



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