J.Jpn. Surg. Soc.. 83(9): 945-948, 1982

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Report on the annual meeting

PRESERVATION OF THE SINUS NODE OR THE RIGHT BUNDLE BRANCH DURING SURGERY FOR ATRIAL OR VENTRICULAR SEPTAL DEFECT

Sick sinus syndrome may occur in otherwise uncomplicated postoperative patients with atrial septal defect. Some of the sick sinus syndrome are considered to be due to pressure injury to the sinus node or its blood supply by the tourniquet around the superior vena cava. Based on this assumption, the superior vena cava was encircled more distally, i.e., in front of the right pulmonary artery in 61 patients operated since 1979. This simple procedure significantly decreased the incidence of the postoperative sick sinus syndrome from 21.5 to 6.6%.
Right bundle branch block is a common conduction disturbance in postoperative patients with perimembranous ventricular septal defect. In order to avoid the main right bundle, the sutures were placed away from the inferior edge of the defect. Special care was taken at the anteroinferior corner of the defect where the bundle is merging into the septomarginal trabecula. This technique reduced the incidence of the complete right bundle branch block from 31.3 to 8.3%.

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