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[Atrio-ventricular disorders following surgery for congenital heart diseases with septal defect (author's transl)]
Insights
Post-operative conduction disorders after septal defect repair are common, especially in Tetralogy of Fallot. Precise localization of the His bundle during surgery can reduce the frequency of these adverse events.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Context:
- Congenital heart diseases with septal defects often lead to post-operative atrioventricular conduction disorders.
- The incidence and type of these disorders vary based on defect location, conduction pathway anatomy, and surgical technique.
Purpose:
- To investigate the incidence and characteristics of atrioventricular conduction disorders following surgical repair of septal defects.
- To evaluate the utility of intracavitary His bundle recording for precise localization of conduction abnormalities.
- To assess the impact of surgical site on the occurrence of conduction disturbances.
Summary:
- Post-operative conduction disorders are frequent after septal defect repair, with varying incidence depending on defect type (e.g., Tetralogy of Fallot vs. ventricular septal defect).
- Intracavitary His bundle recording aids in precise localization of conduction pathway involvement.
- Atrioventricular block, even transient, carries a poor prognosis, necessitating consideration of pacemaker insertion for proximal lesions.
- Continuous intraoperative recording and Holter monitoring are crucial for surveillance due to the high incidence of these disorders.
Impact:
- Identifying critical areas for conduction tissue during surgery can significantly reduce the frequency of post-operative conduction disorders.
- Improved understanding aids in surgical planning and patient management, potentially improving long-term outcomes for congenital heart defect patients.
Abstract:
Post-operative results in congenital heart diseases with septal defect are often darkened by the occurence of disorders in atrio-ventricular conduction. The incidence of these disorders is dependent upon the location of the septal defect, the anatomy of conduction pathways and the operative technique. Intracavitary recording of His bundle activity leads to a more precise localisation of the trouble. Such disorders are more frequent after cure of Fallot's tetralogy than after closure of an interventricular communication. They are rare after closure of an interatrial septal defect and more common after closure of the atrioventricular canal, where they are of atrial node type. The occurrence of an atrioventricular block, even transient, is of poor prognosis, and in case of proximal lesion the insertion of a pacemaker must be considered. The high incidence of conduction disorders justifies continuous per-operative recording and prolonged surveillance, if necessary by Holter's method. Locating the conductive tissue during surgery reduces the frequency.