Late Post-Operative Complete Heart Block after Ventricular Septal Defect Repair Procedure

Article Information

Title: Late Post-Operative Complete Heart Block after Ventricular Septal Defect Repair Procedure

Authors: Sana Imtiaz, Khurram Akhtar, Amjad Mehmood, Hajira Akbar, Nadeem Sadiq, Andaleeb Ara

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30
Y	1900-01-01	2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2022

Volume: 72

Issue: Supplementary 3

Language: English

DOI: 10.51253/pafmj.v72iSUPPL-3.9569

Keywords: Ventricular septal defectComplete heart blockPermanent pacemaker

Abstract

In congenital cardiac surgery, intracardiac repair procedures like ventricular septal defect (VSD), atrioventricular septal defect and tetralogy of fallot (TOF) are associated with conduction system injury. Fewer cases are reported describing life threatening complication of late post-operative complete heart block. We are reporting 2 patients who presented with late complete heart block after ventricular septal defect repair and managed by permanent pacemaker placement in AFIC Cath lab.

Disclaimer: The following sections are produced through an intensive multi-stage analytical pipeline developed by DefinePK, utilizing advanced natural-language processing, domain-specific knowledge models, and automated cross-referencing systems. Despite the rigor and computational effort involved, the generated summary may still contain inaccuracies or incomplete interpretations. Users are strongly advised to verify all critical information against the original paper and its authoritative sources.

Research Objective

To report two cases of late post-operative complete heart block after ventricular septal defect repair and their management with permanent pacemaker placement.

Methodology

Case report of two patients presenting with late complete heart block after ventricular septal defect repair. Management involved permanent pacemaker (PPM) placement.

Methodology Flowchart

                        graph TD;
    A["Identify patients with late post-operative complete heart block after VSD repair"] --> B["Assess symptoms and perform ECG/Echocardiography"];
    B --> C["Confirm Complete Heart Block"];
    C -- Yes --> D["Implant Temporary Pacemaker if symptomatic"];
    D --> E["Plan and perform Permanent Pacemaker Implantation"];
    C -- No --> F["Continue close follow-up"];
    E --> G["Discharge patient in stable condition"];
    G --> H["Regular post-pacemaker follow-up"];

Discussion

Late post-operative CHB is a life-threatening complication of congenital cardiac surgery, occurring more than 30 days after surgery. It can result from direct injury to the atrioventricular node, local edema, or inflammation leading to fibrosis. Regular follow-up and a high index of suspicion are crucial for timely detection and management.

Key Findings

Two pediatric patients, one 9 years old and the other 13 years old, presented with late complete heart block (CHB) after surgical repair of ventricular septal defects (VSD). Both patients were successfully managed with permanent pacemaker implantation.

Conclusion

Late post-operative complete heart block is a serious complication that requires vigilant follow-up and prompt management with permanent pacemaker implantation to prevent morbidity and mortality.

Fact Check

1. Incidence of CHB in congenital cardiac surgery: The text states the incidence of complete heart block in congenital cardiac surgery ranges between 1% to 3%.
2. Incidence of late post-operative heart block: The text reports the incidence of late post-operative heart block to be about 0.3% to 0.7%.
3. Age of patients: The two reported cases involved a 9-year-old male and a 13-year-old male.

Mind Map

Loading PDF...

Loading Statistics...

DefinePK

Select Collection