Etiology of right bundle-branch block pattern after surgical closure of ventricular-septal defects

AbstractTranscatheter closure of ventricular septal defects with the Amplatzer® Membranous VSD Occluder has yielded promising initial results, but disturbances of conduction, including complete heart block, have been reported. We report our experience with the Amplatzer occluder in 35 patients with a median age 4.5 years, the defects being sized angiographically at 4.4 plus or minus 1.1 millimetres, with a range from 3 to 8 millimetres, and the size of the occluder varying from 4 to 12 millimetres. Over a median follow-up of 2.5 years, the rate of complete closure was 87% and 91%, at 1 and 2 years respectively, while 2 patients required surgical closure of the defect subsequent to the insertion of the device. Persistent regurgitation across the tricuspid valve related to the occluder was observed in 3 patients, and in 6 patients across the aortic valve. Abnormalities of conduction related to the procedure were noted in 7 patients, one-fifth of the cohort. The disturbances were transient in 1 patient, but permanent in 6, in one of the latter progressing after 6 months from left bundle branch block to intermittent Mobitz II second-degree atrioventricular block in association with expansion of the occluder. We conclude that transcatheter closure of perimembranous ventricular septal defects with the Amplatzer occluder is effective with limited complications, but the incidence of immediate and progressive disturbances of conduction related to the proximity of conduction tissues to the rims of the occluder stress the importance of larger and longer studies to assess the safety of this procedure.

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Observations on the Occurrence of Right Bundle-Branch Block Following Open Repair of Ventricular Septal Defects

Circulation ◽

10.1161/01.cir.22.5.896 ◽

1960 ◽

Vol 22 (5) ◽

pp. 896-900 ◽

Cited By ~ 37

Author(s):

J. DAVID BRISTOW ◽

DONALD G. KASSEBAUM ◽

ALBERT STARR ◽

HERBERT E. GRISWOLD

Keyword(s):

Right Bundle Branch Block ◽

Open Repair ◽

Ventricular Septal Defects ◽

Bundle Branch Block ◽

Septal Defects

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Faculty Opinions recommendation of Transcatheter versus surgical closure of perimembranous ventricular septal defects in children: a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718270614.793492370 ◽

2014 ◽

Author(s):

Larry Latson ◽

Athar Qureshi

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Ventricular Septal Defects ◽

Surgical Closure ◽

Randomized Controlled ◽

Septal Defects

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Surgical closure of muscular ventricular septal defects using double umbrella devices (intraoperative VSD device closure)

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(97)00086-9 ◽

1997 ◽

Vol 12 (3) ◽

pp. 450-455 ◽

Cited By ~ 21

Author(s):

B Murzi

Keyword(s):

Ventricular Septal Defects ◽

Device Closure ◽

Surgical Closure ◽

Septal Defects

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Initial Design and Evaluation of a Pediatric Intra-Cardiac Camera System for Ventricular Septal Defects

Journal of Medical Devices ◽

10.1115/1.4005778 ◽

2012 ◽

Vol 6 (1) ◽

Author(s):

Mark E. Rentschler ◽

Keir D. Hart ◽

Max B. Mitchell

Keyword(s):

Left Ventricular ◽

Primary Objective ◽

Preliminary Evaluation ◽

Design Development ◽

Ventricular Septal Defects ◽

Camera System ◽

Surgical Closure ◽

Septal Defects ◽

Commercial Device

The primary objective of this project is to design, fabricate, and test a small, integrated camera system for aiding in the visualization and surgical repair of certain types of ventricular septal defects (VSD), in pediatric patients. Currently, no purpose-designed commercial device to view VSDs from the left ventricle of the heart exists. The left ventricular perspective is ideal for obtaining an unobstructed view of the VSD. This VSD camera device would also provide a platform for passing a suture through the hole in the ventricular septum, with future work implementing additional tools capable of more advanced tasks. This camera device will help solve some of the major issues currently associated with cardiac imaging and surgical closure of VSDs in newborns and young children This paper examines the design development and preliminary evaluation of a proof of concept device. Included are preliminary results of image quality comparisons, design details of a pediatric-specific VSD camera device, and initial outcomes from in vitro testing.

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A rare complication of implantable cardiac defibrillator placement

10.21203/rs.2.21549/v1 ◽

2020 ◽

Author(s):

João Ferreira ◽

Célia Marques Domingues ◽

Susana Isabel Costa ◽

Maria Fátima Franco Silva ◽

Lino Manuel Martins Gonçalves

Keyword(s):

Heart Failure ◽

Right Bundle Branch Block ◽

Left Ventricular Systolic Dysfunction ◽

Rare Complication ◽

Systolic Dysfunction ◽

Lateral Wall ◽

Left Ventricular ◽

Refractory Ascites ◽

Bundle Branch Block ◽

Block Pattern

Abstract Background Implantable cardiac defibrillators (ICD) are a popular and effective option in heart failure with left ventricular systolic dysfunction patients. Although frequently underdiagnosed, inadvertent malposition can lead to endocardial damage and thrombotic events. As ICD implants tend to increase in the following years, the recognition of their complications is critical. Case presentation The authors present a case of a 64-year-old woman with advanced heart failure and ICD malposition. This accidental discovery was denounced by the presence of a right bundle branch block pattern and later confirmed by echocardiography which showed the lead tip in contact with the mid segment of the left ventricular antero-lateral wall. As the patient hospitalisation was complicated with refractory ascites and cardiogenic shock, she underwent cardiac transplantation, with no recurrence of heart failure symptoms. Conclusions An electrocardiogram showing a right bundle branch block pattern during VVI pacing should arise the suspicion of inadvertent placement of a pacing/ICD lead. The many facets of echocardiography should be used for the diagnosis of this complication, as they were paramount in this case, as highlighted.

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Surgical closure of ventricular septal defects in Sri Lanka

Ceylon Medical Journal ◽

10.4038/cmj.v50i2.1579 ◽

2010 ◽

Vol 50 (2) ◽

pp. 89

Author(s):

DVT Harischandra ◽

GAC Amarasena

Keyword(s):

Sri Lanka ◽

Ventricular Septal Defects ◽

Surgical Closure ◽

Septal Defects

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Pacemaker and conduction disturbances in patients with atrial septal defect

Cardiology in the Young ◽

10.1017/s1047951120001365 ◽

2020 ◽

Vol 30 (7) ◽

pp. 980-985 ◽

Cited By ~ 1

Author(s):

Diana H. R. Albæk ◽

Sebastian Udholm ◽

Anne-Sif L. Ovesen ◽

Zarmiga Karunanithi ◽

Camilla Nyboe ◽

...

Keyword(s):

Atrial Septal Defect ◽

Atrioventricular Block ◽

Right Bundle Branch Block ◽

Septal Defect ◽

Pacemaker Implantation ◽

Bundle Branch Block ◽

Conduction Disturbances ◽

Septal Defects ◽

Atrial Septal Defects ◽

Background Population

AbstractObjective:To determine the prevalence of pacemaker and conduction disturbances in patients with atrial septal defects.Design:All patients with an atrial septal defect born before 1994 were identified in the Danish National Patient Registry, and 297 patients were analysed for atrioventricular block, bradycardia, right bundle branch block, left anterior fascicular block, left posterior fascicular block, pacemaker, and mortality. Our results were compared with pre-existing data from a healthy background population. Further, outcomes were compared between patients with open atrial septal defects and atrial septal defects closed by surgery or transcatheter.Results:Most frequent findings were incomplete right bundle branch block (40.1%), left anterior fascicular block (3.7%), atrioventricular block (3.7%), and pacemaker (3.7%). Average age at pacemaker implantation was 32 years. Patients with defects closed surgically or by transcatheter had an increased prevalence of atrioventricular block (p < 0.01), incomplete right bundle branch block (p < 0.01), and left anterior fascicular block (p = 0.02) when compared to patients with unclosed atrial septal defects. At age above 25 years, there was a considerably higher prevalence of atrioventricular block (9.4% versus 0.1%) and complete right bundle branch block (1.9% versus 0.4%) when compared to the background cohorts.Conclusions:Patients with atrial septal defects have a considerably higher prevalence of conduction abnormalities when compared to the background population. Patients with surgically or transcatheter closed atrial septal defects demonstrated a higher demand for pacemaker and a higher prevalence of atrioventricular block, incomplete right bundle branch block, and left anterior fascicular block when compared to patients with unclosed atrial septal defects.

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