Conduction disturbances and operative results after closure of ventricular septal defects by three different surgical approaches.

A total of 135 patients with ventricular septal defect (VSD) under 15 years of age, without associated cardiac lesions, underwent surgical repair by 3 different approaches of trans-pulmonary arteriotomy (PA), right atriotomy (RA) and right ventriculotomy (RA) between 1977 and 1981. Six hospital deaths (4.4%) occurred among the 135 patients. Of 41 children with PA, 53 with RA and 41 with RV, one child (2.4%), one child (1.9%) and 4 children (9.9%) died, respectively. In the trans-PA approach, 8 of 40 children (20.0%) developed complete right bundle branch block (CRBBB), but there was no occurrence of left axis deviation (LAD), transient complete heart block (CHB) and arrhythmias postoperatively. In the RA approach, 11 of 52 children (21.2%) developed CRBBB and 2 (3.8%) had a combination of LAD and CRBBB. Four of 52 children (7.7%) had a combination of LAD, CRBBB and CHB, but CHB has been treated successfully with medication. Three patients (5.8%) developed arrhythmias, such as junctional rhythm. In the trans-RV approach, 11 of 37 children (29.7%) developed CRBBB and 4 of the 37 (10.8%) had the combination of LAD and CRBBB. Two patients (5.4%) had arrhythmias which disappeared one month after surgery. All incidences of conduction disturbances and arrhythmias after closure of VSD were significantly less in the trans-PA than in the trans-RA or in the trans-RV (p less than 0.01). However, in the present study, the development of conduction disturbances and postoperative arrhythmias after closure of VSD was not significantly different between the trans-RA and the trans-RV approach.