Methods

The mode of investigation was the same preoperatively as at the follow-up examination. On both occasions the patient was hospitalized, the period of hospitalization being about 7 days for the preoperative examination, and 3-4 days for the follow-up. In all cases these investigations comprised a general clinical examination with full examination of the physical cardiac state, electrocardiogram and phonocardiogram, chest roentgenogram and cardiac catheterization. On catheterization the pressure and flow were determined at rest and during exercise both preand postoperatively in 18 patients, using the same work load on each occasion, and postoperatively alone in 51 patients. General clinical examination. Physical examination was performed personally by the author in all of the follow-up, and also in most of the preoperative investigations, particularly in the children. The case history data concerning the symptoms and functional capacity were evaluated and used as a basis for division into function classes. For adults, function classes as suggested by the New York Heart Association (1964) were used, and for children a modification of Davidsen’s classification ( 1960). The general condition was assessed with especial regard to cardiac failure and complicating diseases, and to any further congenital malformations. The physical cardiac state was evaluated with respect to palpatory precordial activity and auscultatory findings. The palpatory findings were assessed, and signs of increased right ventricular activity were noted. The intensity of the first sound, the degree and variability of splitting of the second sound and the amplitude of the pulmonary component were assessed. The distribution and site of the murmur were determined and the systolic murmurs graded according to Levine & Harvey (1959) at the position of their maxima. Routine blood and urinary analyses were carried out. Electrocardiogram (ECG). In the great majority of cases the EGG was recorded with a four-channel direct-writing apparatus (Mingograf 42, ElemaSchonander Ltd., Stockholm), and in only a few patients before 1959 was the recording made on a three-channel apparatus (Triplex, Elema). Leads I, 11, 111, aVR, aVL and aVF were used, and also, in adults precordial leads Vl-V7, and in children precordial leads V1-