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Updated: Jun 4, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Permanent complete heart block following surgical correction of congenital heart disease
1National Cardiothoracic Centre, Korle Bu Teaching Hospital, P. O. Box KB 846, Korle Bu, Accra.
Insights
Congenital heart repair in Ghana can lead to permanent complete heart block (CHB), especially with large ventricular septal defects (VSDs). Pacemaker implantation has low morbidity, but financial concerns for future surgeries exist.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiac Surgery
Background:
- The incidence of complete heart block (CHB) following congenital heart repairs in Ghana is not well-documented.
- This data is crucial for physicians in Ghana for patient referral, pre-operative counseling, and informed consent processes.
Purpose of the Study:
- To determine the incidence of permanent post-operative CHB requiring pacemaker implantation after congenital heart repair.
- To identify post-operative complications associated with pacemaker implantation in this patient population.
Main Methods:
- A retrospective study design was employed.
- Data was collected from patients who underwent intra-cardiac repair of congenital heart disease at the National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana, between January 1993 and December 2008.
- The frequency of CHB was analyzed based on intra-operative diagnoses.
Main Results:
- Six out of 242 patients (2.5%) developed permanent post-operative CHB.
- CHB occurred in 1.3% of patients with isolated large perimembranous ventricular septal defect (VSD) closures and 5.5% of those with conotruncal anomalies.
- The primary parental concern was the financial burden of future surgeries for pacemaker pulse generator replacement.
Conclusions:
- Permanent post-operative CHB incidence is 1.3% for VSD repair and 5.5% for conotruncal anomaly repair.
- Large perimembranous VSD, isolated or part of conotruncal anomalies, is the main anatomic risk factor for CHB.
- Permanent pacemaker implantation in this context is associated with low morbidity.
Background:
The risk of complete heart block (CHB) from congenital heart repairs in Ghana is unknown. This information is important for referring physicians and in pre-operative counselling of patients and facilitates the process of obtaining informed consent for such repairs.
Objectives:
This study was undertaken to determine the incidence of permanent post-operative CHB requiring pacemaker implantation; and the post-operative problems related to the pacemaker.
Design:
Retrospective study design.
Setting:
The National Cardiothoracic Centre (NCTC), Korle-Bu Teaching Hospital, Accra, Ghana.
Method:
Review of all patients who had intra-cardiac repair of congenital heart disease known to predispose to post-operative complete heart block from January 1993 to December 2008 was carried out with computation of the frequency of complete heart block according to the intra-operative diagnoses.
Results:
Six out of 242 patients (2.5%) developed permanent post-operative CHB. All underwent closure of a large perimembranous ventricular septal defect (VSD) either as an isolated defect (2 of 151 or 1.3%) or in the setting of conotruncal anomalies (4 of 73 or 5.5%). The dominant parental concern relating to the implanted device was the financial implications of future multiple surgeries to replace a depleted pulse generator.
Conclusion:
Permanent post-operative complete heart block occurred in 1.3% of patients undergoing VSD repair and 5.5% of those undergoing repair of conotruncal anomalies (Fallot's tetralogy). The dominant anatomic risk factor was a large perimembranous VSD as an isolated defect or as part of a conotruncal anomaly. Permanent pacemaker implantation in this setting is attended by a low morbidity.
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