Permanent Pacemaker for Atrioventricular Conduction Block After Operative Repair of Perimembranous Ventricular Septal Defect

Abstract

Operative AV block and PPM placement occurred in 1.1% of patients in the total group and in 0.8% of patients comparable to those considered for device closure of PMVSD. A PPM placement is more likely in patients with Down syndrome. These data should be considered as devices are developed and in the future when counseling families about options for PMVSD closure.

Mattress Stitch—A Modified Shallow Stitching in the Surgical Closure of Large Perimembranous Ventricular Septal Defect in Infants

“…17) However, the disturbance of conduction system, residual ventricular shunt, neurologic injury, and postoperative mortality are still major postoperative complications, especially in infants with malnutrition. [6][7][8][9][10][11] Our current series reported excellent postoperative outcomes using mattress suturing technique: there was no incidence of complete heart block, reoperation for residual VSD and postoperative mortality. Some may argue that the results can be attributed simply to a learning curve of the surgeon but the comparatively good outcomes are encouraging, and the new technique can be an addition to the armamentarium of pediatric cardiac surgeons.…”

“…Although complete heart block occurred in less than 1% after surgical closure of VSD, 18) it still remains a complication especially in patients who develop pulmonary hypertension and right ventricle hypertrophy which make the relationship between the conduction branches and the margin of the defect more intimate. 5,7,8) Right bundle branch block, which may be associated with diastolic dysfunction in late follow-up, remains another common conduction disturbance with a reported prevalence of 20%-62%. 12,19,20,21) Both are unequivocally linked to the surgical maneuvers.…”

“…4,5) Complications are rare but still include injury of conduction system, residual shunt, emergent reoperation, and postoperative death, mainly in malnourished infants suffering from large perimembranous VSDs. [6][7][8][9][10][11][12] Since 2011, we have adopted the mattress suturing technique to close the infero-posterior margin of large perimembranous VSDs. In the current series, we retrospectively reviewed 120 infants with poor weight suffering from large perimembranous VSDs to assess this new method and evaluate its effectiveness.…”

Conduction disorders in continuous versus interrupted suturing technique in ventricular septal defect surgical repair

“…Some studies have suggested an association between surgical heart block and small size, but these were inadequately powered to provide definitive data (20,21). Siehr et al (22) have demonstrated that patients weighing less than 4 kilograms were at significantly higher risk for surgical AV block.…”

Percutaneous interventions in adults with congenital heart disease: Expanding indications and opportunities

“…The estimated incidence of complete AV block is 1% to 5% [30,31], and it is more frequently observed in patients weighing less than 10 kg. Complete AV block also occurs after surgical repair of VSDs [32]. The Amplatzer perimembranous VSD occluder has an asymmetrical form specially designed to deal with this issue.…”