J.Jpn. Surg. Soc.. 83(9): 953-957, 1982

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Report on the annual meeting

PREVENTION OF RIGHT BUNDLE BRANCH BLOCK IN CLOSURE OF VENTRICULAR SEPTAL DEFECT IN CONGENITAL HEART ANOMALIES WITH REFERENCE TO TOTAL CORRECTION OF TETRALOGY OF FALLOT

In order to elucidate causative mechanisms involved in surgical right bundle branch block (RBBB), clinical significance of bifascicular block, and topical anatomy of ventricular septal defects (VSD), epicardial mapping, body surface mapping and His bundle electrogram were utilized in total correction of tetralogy. RBBB was classified into central and peripheral blocks arbitrarily. RBBB caused by an injury proximal to the site of insertion of the moderator band was defined as central and that due to distal to moderator band as peripheral block. The central RBBB could be avoided by placing stitches several millimeters away from the posterior margin of VSD and care was taken to avoid injury to the RBBB at the posterocaudal margin by placing sutures a few millimeters apart. Relationship between the right posterior division of the conus septum and the posterior margin of VSD was stressed. In cases of VSD located in the conus septum with the proximal conus septum, sutures could be placed directly on the posterior margin, provided the proximal conus septum was more than 5 millimeters wide. In 82 consecutive cases with tetralogy, RBBB could be avoided in 54 or 62.8% of cases following total correction. Peripheral RBBB could be avoided by a small incision in the outflow portion of the right ventricle and limited wedge resection on the parietal band side of the infundibular stenosis.

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