Heart block after repair of ventricular septal defect in children.

T HE CLOSE anatomic relationship of the conduction system of the heart to most ventricular septal defects'-5 makes the occurrence of complete heart block a potential risk in the repair of these lesions. In our experience , when complete heart block has developed , it has often proved to be a serious complication. Although reversion to sinus rhythm occurs in the early postoperative period in many patients, others have persistent heart block; some of these die either in the immediate postoperative period or at some time after dismissal from the hospital. Of those who survive with complete heart block, some may be symptom-free but a few are troubled with frequent and potentially lethal Stokes-Adams attacks. The purpose of this paper is to review an experience with complete heart block follow-ilng the repair of ventricular septal defect and ventricular septal defect associated with in-fundibular or valvular pulmonic stenosis or with both in the pediatric age group. The data concerning adult patients are not analyzed as yet. We will mention certain changes in surgical technic which seem to have affected the incidence of heart block and will discuss briefly immediate and long-term therapy. with ventricular septal defect and 124 patients with ventricular septal defect associated with in-fundibular or valvular pulmonary stenosis were referred from the Section of Pediatrics for open 526 intracardiae repair. The group of patients designated as "having ventricular septal defect" includes those with isolated ventricular septal defect and those with ventricular septal defect associated with various intracardiae or extracardiae lesions other than p-i.imonic stenosis. Patients with ven-tricular septal defect as part of a common atrio-ventricular canal have been excluded from this study as also have patients with ventricular septal defect associated with corrected transposition of the great vessels. The group of patients described as having ventricular septal defect associated with infundibular or valvular pulmonic stenosis includes those with tetralogy of Fallot as well as those with ventricular septal defect in whom the pulmonic stenosis and the arrangement of the great vessels are not those usually recognized as typical for tetralogv of Fallot. Included in this study were 94 nmale and 80 female patients with ventricular septal defect. Their ages ranged from 21/2 months to la years. Seventy-nine boys and 45 girls had ventricular septal defects associated with infundibular or valvular pul-monic stenosis or with both. Their ages ranged from 6 months to 15 years. Three types of surgical technics …