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Complete right bundle branch block after surgical closure of perimembranous ventricular septal defect. Relation to
Insights
Postoperative right bundle branch block (RBBB) after ventricular septal defect (VSD) repair is less common with direct suture closure. Younger infants and those requiring patch closure face a higher risk of RBBB.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities requiring surgical intervention.
- Postoperative complications, including right bundle branch block (RBBB), can occur following VSD repair.
- Understanding risk factors for RBBB is crucial for optimizing surgical outcomes in pediatric patients.
Purpose of the Study:
- To analyze the incidence of postoperative RBBB after surgical VSD repair in children.
- To identify factors influencing the development of RBBB, such as surgical approach and patient age.
- To compare RBBB incidence with existing literature, particularly regarding ventriculotomy techniques.
Main Methods:
- Retrospective analysis of electrocardiograms (ECGs) from 100 children post-VSD surgical repair.
- Categorization of surgical approaches: atriotomy alone versus atriotomy with ventriculotomy.
- Statistical analysis of ECG findings, correlating RBBB incidence with VSD type, age at surgery, and closure method (suture vs. patch).
Main Results:
- The incidence of complete RBBB (CRBBB) was not higher in the ventriculotomy group compared to the atriotomy group.
- Infants operated on within the first six months of life had a higher propensity for CRBBB.
- Direct suture closure of VSDs was associated with a lower risk of postoperative CRBBB compared to patch closure.
Conclusions:
- The specific type of ventriculotomy used may explain the lower-than-expected incidence of RBBB in this series.
- Younger age at surgery is a significant risk factor for developing CRBBB post-VSD repair.
- Direct suture closure is preferable to patch closure for reducing the risk of RBBB in pediatric VSD surgery.
Abstract:
The ECGs of a 100 consecutive children who had surgical repair of their ventricular septal defects (VSDs) were analyzed for postoperative right bundle branch block (RBBB). Seventy of them had an atriotomy and the other 23 also a ventriculotomy. The ventriculotomy always consisted of a transverse incision a short distance below the pulmonary annulus. Of these children 93 had a perimembranous VSD and the other 7 a pure muscular defect. The ECG results of the 93 children with perimembranous VSDs were statistically analysed. The incidence of postoperative complete RBBB (CRBBB) in the ventriculotomy group was not higher than in the atriotimy group. Infants operated in the first half year of life were more prone to the development of CRBBB than the older children, probably because the VSDs were relatively larger in the younger than the older children. The risk of postoperative CRBBB was less in the children who had direct suture closure of the VSD compared with those who needed a Dacron patch to close the defect. The data in the literature generally indicate a higher incidence of CRBBB after a ventriculotomy than an atriotomy. The absence of this difference and the lower incidence of CRBBB after a ventriculotomy in our series compared with those of several other authors are suggested to be due to the type of ventriculotomy.
