RESUMEN
OBJECTIVE: Secundum atrial septal defect (ASD) is a common congenital heart defect. There is limited data on both early and late atrioventricular (AV) block post ASD closure. The aim of this study was to determine the incidence and risk factors of AV block associated with ASD closure. METHODS: A retrospective analysis of all patients who underwent ASD closure either with a device or surgical method at the Royal Children's Hospital Melbourne between 1996 and 2010 was performed. Baseline demographics, procedural details and follow-up data were collected from medical records. RESULTS: A total of 378 patients were identified; 242 in the device group and 136 in the surgical group. Fourteen patients (3.7%) had AV block (1 with second degree and 13 with first degree) at a median follow-up of 28â months; 11/242 (4.5%) in the device group and 3/135 (2.2%) in the surgical group (p=0.39). Six patients had new-onset AV block after ASD closure. In the device subgroup, patients with AV block at follow-up had a larger indexed device size compared with those without (22 (15-31) vs 18(7-38), p=0.02). Multivariate analysis revealed the presence of AV block either pre procedure or post procedure to be the only variables associated with late AV block. CONCLUSIONS: Late AV block in patients with repaired ASD is rare and most likely independent of the technique used. In the device subgroup, the only risk factor identified to be associated with late AV block was the presence of either preprocedural or postprocedural AV block, so long-term follow-up for these patients should be provided.
RESUMEN
BACKGROUND: The prognosis for hypoplastic left heart syndrome (HLHS) has greatly improved over the past years, but there is still a significant risk of interstage mortality. Tricuspid valve regurgitation (TR) is known to be a risk factor for interstage mortality. We hypothesized that a modified Blalock-Taussig (BT) shunt with a smaller diameter would lead to a reduction in ventricular volume loading with a consequent reduction in TR. METHODS: A retrospective review of all patients with HLHS who had a Norwood procedure in our institution between 2006 and 2011 was performed. Patient demographic, echocardiographic, cardiac magnetic resonance imaging, and operative data were reviewed. The impact of BT shunt diameter on severity of TR at the time of bidirectional cavopulmonary connection (BCPC) was analyzed. RESULTS: Sixty-four neonates with HLHS underwent a Norwood procedure with a BT shunt. Thirty-two had a 3.5-mm BT shunt (3.5-mm group), and 32 had a 3.0-mm BT shunt (3.0-mm group). Survival to BCPC was 53 of 64 patients (83%) overall, with 25 of 32 patients (78%) in the 3.5-mm group and 28 of 32 (88%) in the 3.0-mm group (p = 0.51). The prevalence of significant TR (moderate or higher) before BCPC was 9 of 25 patients (36%) in the 3.5-mm group and 2 of 28 patients (7%) in the 3.0-mm group (odds ratio = 7.3; 95% confidence interval: 1.4-38; p = 0.018). Tricuspid valve repair was performed in 4 of 25 patients (16%) in the 3.5-mm group and 2 of 28 patients (7%) in the 3.0-mm group (p = 0.21). CONCLUSIONS: A smaller-diameter BT shunt reduces the prevalence of significant TR at the time of BCPC. Further investigation and long-term follow-up are required to determine potential complications of this surgical strategy.