Avoidance of surgical right bundle branch block in ventricular septal defect.

Right bundle branch block (RBBB) has been the most frequent conduction disturbance in postoperative patients with a large ventricular septal defect. It has long been considered as an insignificant postoperative sequela. However, recent documentation of its possible deleterious effects on cardiac performance led us to modify the standard technique in an attempt to avoid the postoperative RBBB. In addition to approaching the defect through the right atriotomy, special care was taken for suture placement at the inferior margin and the antero-inferior corner of the defect of defect of perimembranous type. With this technical modification, the frequency of surgical RBBB in patients with a large perimembranous defect has decreased from 31.3 to 8.3 per cent.