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QTc Prolongation after Ventricular Septal Defect Repair in Infants
Chang Woo Han1, Saet Byul Woo1, Jae Young Choi1
1Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
Infant cardiac surgery for ventricular septal defect (VSD) repair can prolong the corrected QT interval (QTc). Factors like Aristotle score and cross-clamp time are associated with this QTc prolongation.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Prolonged corrected QT interval (QTc) is a known risk after cardiac surgery.
- Limited data exists on QTc changes following infant open cardiac surgery for ventricular septal defect (VSD) repair.
Purpose of the Study:
- To investigate QTc interval changes after infant VSD repair.
- To identify post-operative factors associated with QTc prolongation in this population.
Main Methods:
- Retrospective analysis of 105 infants undergoing VSD repair (2008-2012).
- QTc intervals measured pre- and post-operatively.
- Analysis of demographic and peri-procedural data, including Aristotle score, cross-clamp, and bypass times.
Main Results:
- Mean post-operative QTc significantly increased compared to pre-operative measurements (p<0.001).
- Comprehensive Aristotle score (p=0.047), cross-clamp time (p=0.008), and lower infant weight (p=0.042) were associated with QTc prolongation.
- Transient arrhythmias were also linked to QTc prolongation (p=0.005).
Conclusions:
- Infants undergoing VSD repair can experience QTc prolongation post-operatively.
- Peri-procedural factors, including Aristotle score and cross-clamp time, are associated with QTc prolongation.
- QTc prolongation may indicate an increased tendency towards post-operative arrhythmogenicity.
Background And Objectives:
Prolonging of the corrected QT interval (QTc) has been reported after cardiac surgery in some studies. However, there have not been many studies on infant open cardiac surgery for ventricular septal defect (VSD) repair. This study was performed to define the changes in QTc and to find related post-surgery factors in this patient group.
Subjects And Methods:
From 2008 to 2012, 154 infants underwent VSD repair at the Severance Cardiovascular Hospital. This study includes 105 of these cases. QTc was measured in these patients retrospectively. Demographic data and peri-procedural data, such as Aristotle score, cross-clamp time and bypass time, were analyzed. The exclusion criteria included multiple and small VSDs that underwent direct closure.
Results:
Mean post-operative QTc was increased compared to the pre-operative measurements (from 413.6±2.3 to 444.9±2.5, p<0.001). In multiple linear regression, the comprehensive Aristotle score was associated with increasing QTc (p=0.047). The incidence of transient arrhythmia, such as atrial tachycardia, junctional ectopic tachycardia, premature atrial contraction, or premature ventricular contraction, was associated with QTc prolongation (p=0.005). Prolonged QTc was also associated with cross-clamp time (p=0.008) and low weight (p=0.042). Total length of stay at the intensive care unit and intubation time after surgery were not associated with QTc prolongation.
Conclusion:
Prolonged QTc could be seen after VSD repair in infants. This phenomenon was associated with peri-procedural factors such as the Aristotle score and cross-clamp time. Patients with QTc prolongation after cardiac surgery had an increased tendency towards arrhythmogenicity in the post-operative period.
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