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Is complete heart block after surgical closure of ventricular septum defects still an issue?

Henrik Ø Andersen1, Marc R de Leval, Victor T Tsang

  • 1Department of Cardiothoracic Surgery, Rigshospitalet, Denmark. hoandersen@dadlnet.dk

The Annals of Thoracic Surgery
|August 25, 2006
PubMed

Insights

Surgical closure of ventricular septal defects (VSD) can lead to complete heart block. This study identified anatomical factors to minimize this risk, suggesting a less than 1% incidence of iatrogenic heart block after VSD repair.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Pediatric Cardiology

Background:

  • Complete heart block is a serious complication following surgical ventricular septal defect (VSD) closure.
  • Identifying predisposing anatomical features is crucial for preventing surgically-induced heart block.

Purpose of the Study:

  • To review the incidence of complete heart block after VSD closure.
  • To identify anatomical factors predisposing to surgically-induced complete heart block.
  • To provide anatomical guidelines to minimize this complication in future surgeries.

Main Methods:

  • Retrospective study of patients undergoing VSD closure between 1976 and 2001.
  • Data extracted for various VSD types including isolated VSD, tetralogy of Fallot, and aortic arch anomalies.
  • Operative notes of patients with postoperative complete heart block were reviewed for anatomical reasons.

Main Results:

  • 2,079 patients underwent VSD closure.
  • Permanent complete heart block occurred in 0.7% of isolated VSD cases and 0.1% of tetralogy of Fallot cases.
  • Four additional patients experienced postoperative complete heart block.

Conclusions:

  • Iatrogenic complete heart block remains a risk after VSD closure due to biological variations or anatomical unawareness.
  • The study emphasizes the importance of understanding atrioventricular conduction axis disposition.
  • The overall risk of iatrogenic complete heart block after VSD closure is suggested to be less than 1%.
Abstract

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