J.Jpn. Surg. Soc.. 83(9): 949-952, 1982

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Report on the annual meeting

CLINICAL STUDIES ON RIGHT BUNDLE BRANCH BLOCK (RBBB) FOLLOWING CLOSURE OF VENTRICULAR SEPTAL DEFECTS
－On the Incidence of Distal and Proximal RBBB with or Without Right Ventriculotomy (RV-tomy) －

Effects of RV-tomy on RBBB following closure of ventricular septal defects were studied. The incidence of RBBB on ECG following closure of ventricular septal defect (VSD) in 274 patients was reduced significantly from 39.3% in 150 with RV-tomy, to 18.5% in 124 without RV-tomy, especially from 29.8% to 8.5% in supracrital VSD.
In 216 patients, the incidence of RBBB following total correction for tetralogy of Fallot (TF) was reduced from 73.3% in 169 patients with RV-tomy to 59.6% in 47 without RV-tomy, but not significantly, partly due to resection of infundibulum, which was another cause of RBBB in TF.
Out of seventy nine patients following total correction for TF underwent cardiac catheterization, fifty five had RBBB and were divided into two groups. One group was presumed as proximal RBBB because it had the longer (＞ 40 msec) time lag from the point at which systolic pressure curve started rising in the left ventricle, to the point at which it did so in the right ventricle, due to delayed contraction of the whole right ventricle and another, distal RBBB, because it had presumably normal (＜40 msec) time lag, due to delayed contraction of only a part of the right ventricle. Distal RBBB, defined as above, occurred 21.3% in 47 patients with RBBB through RV-tomy and 9.1% in 11 not through RV-tomy.
From these results, closure of ventricular septal defects without RV-tomy in VSD reduced the incidence of distal RBBB, but not significantly in TF.

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