J.Jpn. Surg. Soc.. 83(9): 958-962, 1982

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Report on the annual meeting

CLINICAL CONSIDERATIONS AND LATE RESULTS OF CONDUCTION DISTURBANCE FOLLOWING INTRACARDIAC REPAIR OF CONGENITAL HEART DISEASES

Influences of surgical repair of VSD, TOF and ASD on intracardiac conduction system were discussed retrospectively. From the point of surgical approach in VSD closure, patients were divided into 3 groups; right ventriculotomy (RV) group, right atriotomy (RA) group and pulmonary arteriotomy (PA) group. In 33 cases of RV group, 8 cases of CRBBB, 2 of CRBBB and LAD, and 2 of complete A-V block developed. Non-right ventriculotomy approaches reduced the incidence of surgical conduction disturbances; only 3 cases of CRBBB (13.6%) in 22 cases of RA group and 1 case of CRBBB (20%) in 5 cases of PA group.
Total repair for TOF in 50 cases with large infundibular muscle resection developed 44 cases of surgical conduction disturbances (88%), while recent 30 cases limited infundubular muscle resection showed only 14 cases of surgical conduction disturbances (46.6%). A case of recurrent sustained ventricular tachycardia which developed after total repair for TOF could be treated only by right ventricular overdrive pacing with implantable radiofrequency pacemaker.
Preoperative and postoperative arrhythmias in 18 cases of ASD were studied by His bundle electrograms. Preoperatively ASD cases over 35 years old showed prolonged refractory periods of A-V node probably because of volume overload in the right heart. Postoperative arrhythmias in ASD closure may be probably due to occurrence of the latent conduction disturbances in sino-atrial or atrio- A-V nodal junction.

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