Risk Factors and Outcomes of Complete Heart Block in Children after Surgical Closure of Ventricular Septal Defects: The Role of Pacemaker Therapy
Moshera Mohamed El Nady
Pediatrics Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Doaa Mohamed El Amrousy
Pediatrics Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Wael Mohamed Lotfy
Pediatrics Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Amr Mohamed Zoair
Pediatrics Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: Many issues might arise with surgical closure, such as postoperative pain, sternotomy scar, and postoperative arrhythmias as well as heart block. The purpose of this study was to identify the risk factors for complete heart block (CHB) among children following surgical ventricular septal defect (VSD) closure.
Methods: This retrospective work was performed on 126 pediatric individuals, with a history of VSD closure surgically. There were two groups of participants: Group 1 (Post-surgical CHB group): (n=42) had CHB. and Group 2 (Post-surgical non CHB group): (n=84) without CHB.
Results: Temporary Pacemaker was needed in 11 cases (26.19%), temporary then endocardial pacemaker occurred in 21 cases (50%), epicardial pacemaker occurred in 3 cases (7.14%), and endocardial pacemaker in 7 cases (16.67%). No complications occurred in 38 cases (90.48%), sepsis after one week occurred in 1 case (2.38%). Body weight at closure, type of VSD, mean pulmonary arterial pressure (mPAP) before surgery and procedure time were independent significant predictors for occurrence of CHB (P<0.05).
Conclusions: Low body weight at closure, large peri-membranous and inlet VSD, high mPAP before surgery were independent significant risk factors or predictors for occurrence of CHB after surgical closure of VSD. Pacemaker therapy is the only beneficial therapy of post-operative CHB.
Keywords: Risk factors, complete heart block, pacemaker therapy, ventricular septal defects, surgical closure