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Does Surgically Induced Right Bundle Branch Block Really Effect Ventricular Function in Children After Ventricular Septal Defect Closure?

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An Erratum to this article was published on 21 March 2015

Abstract

In this prospective study, we aimed to assess left and right ventricular function in terms of the presence of right bundle branch block (RBBB) in the cases with repaired ventricular septal defect (VSD). Fifty-three patients who had VSD surgery at least 1-year preceding admission and 52 healthy controls were enrolled into the study. All the participants underwent electrocardiographic and echocardiographic examination. The cases with RBBB were determined. The conventional and tissue Doppler echocardiographic measurements of the patients with and without RBBB were compared with each other and healthy controls. Twenty-eight of VSD repair groups were male and 25 were female. Control group consisted of 30 males and 22 females. The mean age of the study and control groups was 7.5 ± 5.0 and 6.9 ± 4.3 years, respectively. RBBB was detected in 20 of 53 (37.7 %) operated patients. The only significant difference between the cases with and without RBBB was decreased right ventricular fractional area change (%) in the former group (33 ± 7 vs. 39 ± 5 p < 0.05). When compared to controls, operated group had statistically higher tricuspid annular plane systolic excursion (p < 0.05), lower systolic, early diastolic, and late diastolic myocardial velocities, higher left and right ventricular myocardial performance indices, irrespective of the presence of RBBB. The ratios of mitral or tricuspid inflow to left or right ventricular myocardial in early diastolic velocities measured from lateral annular levels were increased in operated group (all p values <0.05). In conclusion, RBBB in the cases with surgical VSD repair might be associated with right ventricular dysfunction. Biventricular systolic and diastolic dysfunction may develop following VSD repair irrespective of the presence of RBBB. Tissue Doppler-derived myocardial performance indices are useful in detection of those subclinical dysfunctions.

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References

  1. Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Alexi-Meskischvili V, Gutberlet M, Hetzer R et al (2002) Value of the new Doppler-derived myocardial performance index for the evaluation of right and left ventricular function following repair of tetralogy of fallot. Pediatr Cardiol 23:502–507

    Article  CAS  PubMed  Google Scholar 

  2. Abd El Rahman MY, Hui W, Yigitbasi M, Dsebissowa F, Schubert S, Hetzer R et al (2005) Detection of left ventricular asynchrony in patients with right bundle branch block after repair of tetralogy of Fallot using tissue-Doppler imaging-derived strain. J Am Coll Cardiol 45:915–921

    Article  PubMed  Google Scholar 

  3. Adams JC, Nelson MR, Chandrasekaran K, Jahangir A, Srivathsan K (2013) Novel ECG criteria for right ventricular systolic dysfunction in patients with right bundle branch block. Int J Cardiol 167:1385–1389

    Article  PubMed  Google Scholar 

  4. Almeida AR, Loureiro MJ, Lopes L, Cotrim C, Lopes L, Repolho D et al (2014) Echocardiographic assessment of right ventricular contractile reserve in patients with pulmonary hypertension. Rev Port Cardiol 33:155–163

    PubMed  Google Scholar 

  5. Anavekar NS, Skali H, Bourgoun M, Ghali JK, Kober L, Maggioni AP et al (2008) Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study). Am J Cardiol 101:607–612

    Article  PubMed  Google Scholar 

  6. Andersen HØ, de Leval MR, Tsang VT, Elliott MJ, Anderson RH, Cook AC (2006) Is complete heart block after surgical closure of ventricular septum defects still an issue? Ann Thorac Surg 82:948–956

    Article  PubMed  Google Scholar 

  7. Asano Y, Izumida N, Kiyohara K, Hosaki J, Kawano S, Sawanobori T et al (1995) Diagnosis of right ventricular overload by body surface QRST isointegral maps in children with postoperative right bundle branch block. J Electrocardiol 28:209–221

    Article  CAS  PubMed  Google Scholar 

  8. Auricchio A, Lumens J, Prinzen FW (2014) Does cardiac resynchronization therapy benefit patients with right bundle branch block: cardiac resynchronization therapy has a role in patients with right bundle branch block. Circ Arrhythm Electrophysiol 7:532–542

    Article  PubMed  Google Scholar 

  9. Baghdady Y, Kamel Y, Amar W (2010) Myocardial performance index after surgical correction of ventricular septal defects. Arch Med Sci 6:328–335

    Article  PubMed Central  PubMed  Google Scholar 

  10. Bordachar P, Iriart X, Chabaneix J, Sacher F, Lafitte S, Jais P (2008) Presence of ventricular dyssynchrony and haemodynamic impact of right ventricular pacing in adults with repaired Tetralogy of Fallot and right bundle branch block. Europace 10:967–971

    Article  PubMed  Google Scholar 

  11. Dubin AM, Feinstein JA, Reddy VM, Hanley FL, Van Hare GF, Rosenthal DN (2003) Electrical resynchronization a novel therapy for the failing right ventricle. Circulation 107:2287–2289

    Article  PubMed  Google Scholar 

  12. Eun LY, Park HK, Choi JY (2013) How is the peri-patch myocardium in ventricular septal defect patch repair? J Cardiol 61:354–358

    Article  PubMed  Google Scholar 

  13. Gorcsan J, Gulati VK, Mandarino WA, Katz WE (1996) Color coded measures of myocardial velocity throughout the cardiac cycle by tissue Doppler imaging to quantify regional left ventricular function. Am Heart J 131:1203–1213

    Article  PubMed  Google Scholar 

  14. Haddad F, Denault AY, Couture P, Cartier R, Pellerin M, Levesque S et al (2007) Right ventricular myocardial performance index predicts perioperative mortality or circulatory failure in high-risk valvular surgery. J Am Soc Echocardiogr 20:1065–1072

    Article  PubMed  Google Scholar 

  15. Harada K, Tamura M, Toyono M, Yasuoka K (2002) Comparison of the right ventricular Tei index by tissue Doppler imaging to that obtained by pulsed Doppler in children without heart disease. Am J Cardiol 90:566–569

    Article  PubMed  Google Scholar 

  16. Hayabuchi Y, Matsuoka S, Kubo M, Kuroda Y (1998) Usefulness of color kinesis imaging for evaluation of regional right ventricular wall motion in patients with surgically repaired tetralogy of Fallot. Am J Cardiol 82:1224–1229

    Article  CAS  PubMed  Google Scholar 

  17. Ho CY, Solomon SD (2006) A clinician’s guide to tissue Doppler imaging. Circulation 113:396–398

    Article  Google Scholar 

  18. Klitsie LM, Kuipers IM, Roest AA, Van der Hulst AE, Stijnen T, Hazekamp MG et al (2013) Disparity in right versus left ventricular recovery during follow-up after ventricular septal defect correction in children. Eur J Cardiothorac Surg 44:269–274

    Article  PubMed  Google Scholar 

  19. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) Recommendations for chamber quantification: a report from the american society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the european association of echocardiography, a branch of the european society of cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  20. Matsuhisa H, Yoshimura N, Higuma T, Misaki T, Onuma Y, Ichida F et al (2013) Ventricular septal dysfunction after surgical closure of multiple ventricular septal defects. Ann Thorac Surg 96:891–897

    Article  PubMed  Google Scholar 

  21. McMahon CJ, Nagueh SF, Eapen RS, Dreyer WJ, Finkelshtyn I, Cao X et al (2004) Echocardiographic predictors of adverse clinical events in children with dilated cardiomyopathy: a prospective clinical study. Heart 90:908–915

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Meijboom F, Szatmari A, Utens E, Deckers JW, Roelandt JR, Bos E et al (1994) Long-term follow-up after surgical closure of ventricular septal defect in infancy and childhood. J Am Coll Cardiol 24:1358–1364

    Article  CAS  PubMed  Google Scholar 

  23. Mueller C, Laule-Kilian K, Klima T, Breidthardt T, Hochholzer W, Perruchoud AP et al (2006) Right bundle branch block and long-term mortality in patients with acute congestive heart failure. J Intern Med 260:421–428

    Article  CAS  PubMed  Google Scholar 

  24. Oki T, Tabata T, Yamada H, Wakatsuki T, Shinohara H, Nishikado A et al (1997) Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation. Am J Cardiol 79:921–928

    Article  CAS  PubMed  Google Scholar 

  25. Okoroma EO, Guller B, Maloney JD, Weidman WH (1975) Etiology of right bundle-branch block pattern after surgical closure of ventricular-septal defects. Am Heart J 90:14–18

    Article  CAS  PubMed  Google Scholar 

  26. Pedersen TA, Andersen NH, Knudsen MR, Christensen TD, Sørensen KE, Hjortdal VE (2008) The effects of surgically induced right bundle branch block on left ventricular function after closure of the ventricular septal defect. Cardiol Young 18:430–436

    PubMed  Google Scholar 

  27. Rojo EC, Rodrigo JL, Pérez de Isla L, Almería C, Gonzalo N, Aubele A et al (2006) Disagreement between tissue Doppler imaging and conventional pulsed wave Doppler in the measurement of myocardial performance index. Eur J Echocardiogr 7:356–364

    Article  PubMed  Google Scholar 

  28. Roos-Hesselink JW, Meijboom FJ, Spitaels SE, Van Domburg R, Van Rijen EH, Utens EM et al (2004) Outcome of patients after surgical closure of ventricular septal defect at young age: longitudinal follow-up of 22–34 years. Eur Heart J 25:1057–1062

    Article  CAS  PubMed  Google Scholar 

  29. Stegemann B, Dreger H, Ismer B, Baumann G, Melzer C (2013) Left ventricular asynchrony in patients with right bundle branch block and normal ejection fraction. Pacing Clin Electrophysiol 36:63–68

    Article  PubMed  Google Scholar 

  30. Takamatsu H, Tada H, Okaniwa H, Toide H, Maruyama H, Higuchi R et al (2008) Right bundle branch block and impaired left ventricular function as evidence of a left ventricular conduction delay. Circ J 72:120–126

    Article  PubMed  Google Scholar 

  31. Tei C (1995) New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 26:135–136

    CAS  PubMed  Google Scholar 

  32. van Lier TA, Harinck E, Hitchcock JF, Moulaert AJ, van Mill GJ (1985) Complete right bundle branch block after surgical closure of perimembranous ventricular septal defect. Relation to type of ventriculotomy. Eur Heart J 6:959–962

    PubMed  Google Scholar 

  33. Veeram Reddy SR, Du W, Zilberman MV (2009) Left ventricular mechanical synchrony and global systolic function in pediatric patients late after ventricular septal defect patch closure: a three-dimensional echocardiographic study. Congenit Heart Dis 4:454–458

    Article  PubMed  Google Scholar 

  34. Zacharska-Kokot E (2007) The myocardial performance index in children after surgical correction of congenital malformations with intracardiac shunt. Kardiologia polska 65:143–150 abstract

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Departmet of Pediatric Cardiology, School of Medicine, Ankara University, Cebeci, 06620, Ankara, Turkey

    Cem Karadeniz, Semra Atalay, Fikri Demir, Ercan Tutar, Omer Ciftci & Tayfun Ucar

  2. Departmet of Cardiovascular Surgery, School of Medicine, Ankara University, Ankara, Turkey

    Adnan Uysalel & Zeynep Eyileten

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  1. Cem Karadeniz
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Correspondence to Cem Karadeniz.

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Karadeniz, C., Atalay, S., Demir, F. et al. Does Surgically Induced Right Bundle Branch Block Really Effect Ventricular Function in Children After Ventricular Septal Defect Closure?. Pediatr Cardiol 36, 481–488 (2015). https://doi.org/10.1007/s00246-014-1037-9

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  • DOI: https://doi.org/10.1007/s00246-014-1037-9

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