Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1982 Apr;47(4):305–315. doi: 10.1136/hrt.47.4.305

Conduction defects, ventricular arrhythmias, and late death after surgical closure of ventricular septal defect.

R S Blake, E E Chung, H Wesley, K A Hallidie-Smith
PMCID: PMC481141  PMID: 7066115

Abstract

One hundred and eighty-seven patients who had surgical closure of a ventricular septal defect between 1958 and 1975 were followed for up to 21 years. there were 17 late sudden deaths of which eight occurred in completely fit patients while nine were already under medical care. In an attempt to elucidate possible risk factors and reoperative and serial postoperative electrocardiograms of all patients were studied. Fifty-one unselected healthy follow-up patients agreed to 24 hour ambulatory monitoring. Progressive exercise testing (Bruce protocol) was carried out on 31 of them and an additional seven patients. There was a significant correlation between recorded ventricular arrhythmias and conduction defects, particularly progressive conduction defects. Transient complete heart block carried a bad prognosis and grade 3-4b ventricular arrhythmias were a major risk factor and recorded in 10 of the 17 patients who died. Long-term postoperative electrocardiographic follow-up is recommended and 24 hour ambulatory monitoring and exercise testing complement the findings of the resting electrocardiogram. The long-term treatment of survivors found to have ventricular arrhythmias must be considered.

Full text

PDF
305

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen H. D., Anderson R. C., Noren G. R., Moller J. H. Postoperative follow-up of patients with ventricular septal defect. Circulation. 1974 Sep;50(3):465–471. doi: 10.1161/01.cir.50.3.465. [DOI] [PubMed] [Google Scholar]
  2. Antman E., Graboys T. B., Lown B. Continuous monitoring for ventricular arrhythmias during exercise tests. JAMA. 1979 Jun 29;241(26):2802–2805. [PubMed] [Google Scholar]
  3. Brodsky M., Wu D., Denes P., Kanakis C., Rosen K. M. Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease. Am J Cardiol. 1977 Mar;39(3):390–395. doi: 10.1016/s0002-9149(77)80094-5. [DOI] [PubMed] [Google Scholar]
  4. Bruce R. A. Exercise testing of patients with coronary heart disease. Principles and normal standards for evaluation. Ann Clin Res. 1971 Dec;3(6):323–332. [PubMed] [Google Scholar]
  5. Clark D. S., Hirsch H. D., Tamer D. M., Gelband H. Electrocardiographic changes following surgical treatment of congenital cardiac malformations. Prog Cardiovasc Dis. 1975 May-Jun;17(6):451–465. doi: 10.1016/s0033-0620(75)80004-1. [DOI] [PubMed] [Google Scholar]
  6. Corone P., Doyon F., Gaudeau S., Guérin F., Vernant P., Ducam H., Rumeau-Rouquette C., Gaudeul P. Natural history of ventricular septal defect. A study involving 790 cases. Circulation. 1977 Jun;55(6):908–915. doi: 10.1161/01.cir.55.6.908. [DOI] [PubMed] [Google Scholar]
  7. Deanfield J. E., McKenna W. J., Hallidie-Smith K. A. Detection of late arrhythmia and conduction disturbance after correction of tetralogy of Fallot. Br Heart J. 1980 Sep;44(3):248–253. doi: 10.1136/hrt.44.3.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Downing J. W., Jr, Kaplan S., Bove K. E. Postsurgical left anterior hemiblock and right bundle-branch block. Br Heart J. 1972 Mar;34(3):263–270. doi: 10.1136/hrt.34.3.263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gelband H., Waldo A. L., Kaiser G. A., Bowman F. O., Jr, Malm J. R., Hoffman B. F. Etiology of right bundle-branch block in patients undergoing total correction of tetralogy of Fallot. Circulation. 1971 Dec;44(6):1022–1033. doi: 10.1161/01.cir.44.6.1022. [DOI] [PubMed] [Google Scholar]
  10. Godman M. J., Roberts N. K., Izukawa T. Late postoperative conduction distrubances after repair of ventricular septal defect and tetralogy of Fallot. Analysis by his bundle recordings. Circulation. 1974 Feb;49(2):214–221. doi: 10.1161/01.cir.49.2.214. [DOI] [PubMed] [Google Scholar]
  11. Hallidie-Smith K. A., Wilson R. S., Hart A., Zeidifard E. Functional status of patients with large ventricular septal defect and pulmonary vascular disease 6 to 16 years after surgical closure of their defect in childhood. Br Heart J. 1977 Oct;39(10):1093–1101. doi: 10.1136/hrt.39.10.1093. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hobbins S. M., Izukawa T., Radford D. J., Williams W. G., Trusler G. A. Conduction disturbances after surgical correction of ventricular septal defect by the atrial approach. Br Heart J. 1979 Mar;41(3):289–293. doi: 10.1136/hrt.41.3.289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Horowitz L. N., Simson M. B., Spear J. F., Josephson M. E., Moore E. N., Alexander J. A., Kastor J. A., Edmunds L. H., Jr The mechanism of apparent right bundle branch block after transatrial repair of tetralogy of Fallot. Circulation. 1979 Jun;59(6):1241–1252. doi: 10.1161/01.cir.59.6.1241. [DOI] [PubMed] [Google Scholar]
  14. James F. W., Kaplan S., Chou T. C. Unexpected cardiac arrest in patients after surgical correction of tetralogy of Fallot. Circulation. 1975 Oct;52(4):691–695. doi: 10.1161/01.cir.52.4.691. [DOI] [PubMed] [Google Scholar]
  15. LEV M., FELL E. H., ARCILLA R., WEINBERG M. H. SURGICAL INJURY TO THE CONDUCTION SYSTEM IN VENTRICULAR SEPTAL DEFECT. Am J Cardiol. 1964 Oct;14:464–476. doi: 10.1016/0002-9149(64)90030-x. [DOI] [PubMed] [Google Scholar]
  16. Maron B. J., Redwood D. R., Hirshfeld J. W., Jr, Goldstein R. E., Morrow A. G., Epstein S. E. Postoperative assessment of patients with ventricular septal defect and pulmonary hypertension. Response to intense upright exercise. Circulation. 1973 Oct;48(4):864–874. doi: 10.1161/01.cir.48.4.864. [DOI] [PubMed] [Google Scholar]
  17. Moreno-Cabral R. J., Mamiya R. T., Nakamura F. F., Brainard S. C., McNamara J. J. Ventricular septal defect and aortic insufficiency. Surgical treatment. J Thorac Cardiovasc Surg. 1977 Mar;73(3):358–365. [PubMed] [Google Scholar]
  18. Okoroma E. O., Guller B., Maloney J. D., Weidman W. H. Etiology of right bundle-branch block pattern after surgical closure of ventricular-septal defects. Am Heart J. 1975 Jul;90(1):14–18. doi: 10.1016/0002-8703(75)90251-3. [DOI] [PubMed] [Google Scholar]
  19. Rein J. G., Freed M. D., Norwood W. I., Castaneda A. R. Early and late results of closure of ventricular septal defect in infancy. Ann Thorac Surg. 1977 Jul;24(1):19–27. doi: 10.1016/s0003-4975(10)64563-8. [DOI] [PubMed] [Google Scholar]
  20. Ryan M., Lown B., Horn H. Comparison of ventricular ectopic activity during 24-hour monitoring and exercise testing in patients with coronary heart disease. N Engl J Med. 1975 Jan 30;292(5):224–229. doi: 10.1056/NEJM197501302920502. [DOI] [PubMed] [Google Scholar]
  21. Sigmann J. M., Perry B. L., Gehrendt D. M., Stern A. M., Kirsh M. M., Sloan H. E. Ventricular septal defect: results after repair in infancy. Am J Cardiol. 1977 Jan;39(1):66–71. doi: 10.1016/s0002-9149(77)80013-1. [DOI] [PubMed] [Google Scholar]
  22. Vogel J. H., Grover R. F., Jamieson G., Blount S. G., Jr Long-term physiologic observations in patients with ventricular septal defect and increased pulmonary vascular resistance (with 2 color plates). Adv Cardiol. 1974;11(00):108–122. doi: 10.1159/000395209. [DOI] [PubMed] [Google Scholar]
  23. Weidman W. H., DuShane J. W. Course of pulmonary hypertension following surgical closure of ventricular septal defect. Adv Cardiol. 1974;11(00):131–134. doi: 10.1159/000395211. [DOI] [PubMed] [Google Scholar]
  24. Wolff G. S., Rowland T. W., Ellison R. C. Surgically induced right bundle-branch block with left anterior hemiblock. An ominous sign in postoperative tetralogy of Fallot. Circulation. 1972 Sep;46(3):587–594. doi: 10.1161/01.cir.46.3.587. [DOI] [PubMed] [Google Scholar]
  25. Yabek S. M., Jarmakani J. M., Roberts N. K. Diagnosis of trifasicular damage following tetralogy of fallot and ventricular septal defect repair. Circulation. 1977 Jan;55(1):23–27. doi: 10.1161/01.cir.55.1.23. [DOI] [PubMed] [Google Scholar]
  26. Ziady G. M., Hallidie-Smith K. A., Goodwin J. F. Conduction disturbances after surgical closure of ventricular septal defect. Br Heart J. 1972 Dec;34(12):1199–1204. doi: 10.1136/hrt.34.12.1199. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES