CONDUCTION DEFECTS FOLLOWING VENTRICULAR SEPTAL DEFECT CLOSURE WITH AND WITHOUT A RIGHT VENTRICULOTOMY

Abstract

It has been reported from our institution that almost all patients (pts) with tetralogy of Fallot develop a right bundle branch block pattern (RBBBP) postop and in addition 8.7% develop a left anterior hemiblock pattern (LAHP). To evaluate the occurrence of postop ventricular conduction defects the surgical procedures and pre and postop electrocardiograms of 70 pts with isolated ventricular septal defect (VSD) in whom the repair was carried out via a right ventriculotomy and 52 pts with VSD repaired via the atrium were reviewed. Of the 70 pts who had a right ventriculotomy 57 (81%) developed an RBBBP and 13 (19%) had no conduction abnormalities. No pt developed LAHP. Among the 52 pts repaired without a right ventriculotomy 13 (25%) developed an RBBBP and in addition 3 of the 13 had LAHP. The other 39 (75%) pts had no conduction defects after surgery. VSD size, location and use of suture vs. patch closure for VSD repair were similar for both groups. Our results indicate that 1) the incidence of RBBBP following VSD closure via the atrium is less frequent than previously reported; 2) RBBBP is more frequent when VSD is repaired via a right ventriculotomy suggesting that most lesions following ventriculotomy are due to peripheral injury of the right bundle branch; 3) when RBBBP and LAHP develop following VSD repair via the atrium, the lesion must be considered central in origin.

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