Ventricular arrhythmias after correction of ventricular septal defects: importance of surgical approach

Department of Pediatric Cardiology, Sainte-Justine Hospital, Montreal, Quebec, Canada.

To compare the prevalence of conduction disturbances and ventricular arrhythmias in cases of postoperative ventricular septal defect, 100 patients (50 with repair by right atriotomy, group 1; and 50 with repair by right ventriculotomy, group 2) underwent complete evaluation including an electrocardiogram (ECG) and 24 h ambulatory ECG monitoring. The two groups were comparable except for a shorter follow-up duration (7 +/- 3 versus 12.4 +/- 7 years) and a younger age at evaluation (12.4 +/- 5 versus 16.9 +/- 7 years) in group 1. Complete right bundle branch block was less frequent in group 1 than in group 2 (20% versus 50%, p less than 0.05) but three of the four patients with complete atrioventricular (AV) block detected on ambulatory monitoring were in group 1. Six patients had significant supraventricular arrhythmias, all well tolerated. Ambulatory monitoring revealed significant ventricular arrhythmias (modified Lown grade 2 or higher) in 39 patients, with a lower prevalence in group 1 (30% versus 48%, p = 0.05). No correlation was found between prevalence of ventricular arrhythmias and right ventricular systolic pressure, cardiopulmonary bypass duration, presence of a synthetic patch, previous pulmonary artery banding, presence of complete right bundle branch block and cardiomegaly on chest X-ray film. Prevalence of ventricular arrhythmias increased with follow-up duration, age at evaluation and age at surgery. These were always well tolerated and did not warrant treatment. Thus, right atriotomy reduces the prevalence of right bundle branch block but does not prevent late AV block. Ventricular arrhythmias are frequent after surgical closure of ventricular septal defect whatever the surgical approach and their prevalence is not statistically different from that in postoperative tetralogy of Fallot.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				H. O. Andersen, M. R. de Leval, V. T. Tsang, M. J. Elliott, R. H. Anderson, and A. C. Cook Is complete heart block after surgical closure of ventricular septum defects still an issue? Ann. Thorac. Surg., September 1, 2006; 82(3): 948 - 956. [Abstract] [Full Text] [PDF]

				P. Engelfriet, E. Boersma, E. Oechslin, J. Tijssen, M. A. Gatzoulis, U. Thilen, H. Kaemmerer, P. Moons, F. Meijboom, J. Popelova, et al. The spectrum of adult congenital heart disease in Europe: morbidity and mortality in a 5 year follow-up period: The Euro Heart Survey on adult congenital heart disease Eur. Heart J., November 1, 2005; 26(21): 2325 - 2333. [Abstract] [Full Text] [PDF]

				J.W Roos-Hesselink, F.J Meijboom, S.E.C Spitaels, R van Domburg, E.H.M van Rijen, E.M.W.J Utens, A.J.J.C Bogers, and M.L Simoons Outcome of patients after surgical closure of ventricular septal defect at young age: longitudinal follow-up of 22-34 years Eur. Heart J., June 2, 2004; 25(12): 1057 - 1062. [Abstract] [Full Text] [PDF]

				M K. Demirag, H. T. Keceligil, and F. Kolbakir Primary Surgical Repair of Ventricular Septal Defect Asian Cardiovasc Thorac Ann, September 1, 2003; 11(3): 213 - 216. [Abstract] [Full Text]

				T. Fukuda, T. Suzuki, I. Kashima, M. Sato, and Y. Morikawa Shallow stitching close to the rim of the ventricular septal defect eliminates injury to the right bundle branch Ann. Thorac. Surg., August 1, 2002; 74(2): 550 - 555. [Abstract] [Full Text] [PDF]

				H. M. Gabriel, M. Heger, P. Innerhofer, M. Zehetgruber, G. Mundigler, M. Wimmer, G. Maurer, and H. Baumgartner Long-term outcome of patients with ventricular septal defect considered not to require surgical closure during childhood J. Am. Coll. Cardiol., March 20, 2002; 39(6): 1066 - 1071. [Abstract] [Full Text] [PDF]

				J.-P. Pfammatter, B. Wagner, P. Berdat, D. C. G. Bachmann, M. Pavlovic, J. Pfenninger, and T. Carrel Procedural factors associated with early postoperative arrhythmias after repair of congenital heart defects J. Thorac. Cardiovasc. Surg., February 1, 2002; 123(2): 258 - 262. [Abstract] [Full Text] [PDF]

				Z. Amin, X. Gu, J. M. Berry, J. L. Bass, J. L. Titus, M. Urness, Y.-M. Han, and K. Amplatz New Device for Closure of Muscular Ventricular Septal Defects in a Canine Model Circulation, July 20, 1999; 100(3): 320 - 328. [Abstract] [Full Text] [PDF]

				Y.-C. Wu, C.-H. Chang, P. Jing Lin, J.-J. Chu, Hui-Ping Liu, M.-W. Yang, H.-C. Hsieh, and F.-C. Tsai Minimally invasive cardiac surgery for intracardiac congenital lesions Eur. J. Cardiothorac. Surg., October 1, 1998; 14(suppl_1): S154 - S159. [Abstract] [Full Text] [PDF]

				P. J. Lin, C.-H. Chang, J.-J. Chu, H.-P. Liu, F.-C. Tsai, W.-J. Su, M.-W. Yang, and P. P. C. Tan Minimally Invasive Cardiac Surgical Techniques in the Closure of Ventricular Septal Defect: An Alternative Approach Ann. Thorac. Surg., January 1, 1998; 65(1): 165 - 169. [Abstract] [Full Text] [PDF]