[Experimental study on avoidance of surgical heart block in septation for single ventricle].

ABSTRACT

A new method was developed to prevent surgical injury of the atrioventricular conduction system in septation for single ventricle. The new method includes the use of small Teflon pledgets to cover the conduction system at the crossing sites of suture line, and so that stitches can be placed on the pledgets to skip the conduction system. This paper describes the results of an experimental study to delineate the effects of covering pledgets on the morphology and function of the underlying conduction tissues. Deep hypothermia was employed for this experiment in 15 mongrel dogs. The small Teflon pledgets were sutured to bridge the endocardial surface of the atrioventricular node through the right atriotomy. They were subjected to sacrifice at 1 week to 12 months postoperatively. Electrophysiological study including electrocardiography. His bundle electrography and responsiveness of the atrioventricular conduction to rapid stimulation was done before the sacrifice. The resected heart was embedded in Ceroidin-Paraffin and serially sectioned for pathological study. No noticeable injuries were noted in the underlying conduction system. The electrophysiological study showed normal sinus rhythm at the time of sacrifice. No significant changes were noted in PQ intervals comparing to preoperative state. There were no significant differences in AH intervals, HV intervals and responsiveness to rapid atrial stimulation between experimental and normal control groups. In conclusion, the Teflon felt pledgets were demonstrated to have no detrimental effects on the atrioventricular conduction system in the chronic stage.