[Late ventricular tachycardia after surgical correction of congenital cardiopathy. Impact, severity and predictive factors].
A group of 6 patients operated for Fallot's tetralogy (4 cases) or a similar congenital cardiac malformation (2 cases) were studied to assess the prevalence, severity and predictive factors of late post-operative ventricular tachycardia. These 6 patients were compared with a control group of 44 patients undergoing complete correction of Fallot's tetralogy. The age at operation (6 +/- 2 years), the length of follow-up (8 +/- 2.5 years) and surgical technique were comparable in both groups. The clinical parameters and results of non-invasive investigations (resting ECG, Holter monitoring) were compared. The first attack of tachycardia occurred on average 3 years after surgery. A triggering factor was found in 3 cases (a blow on the chest--2 cases--, general anaesthesia--1 case). These postoperative tachycardias are characterised by poor clinical tolerance, a tendency to recur, resistance to therapy and reserved prognosis. They are significantly commoner in patients operated late and in those with a poor haemodynamic result: right ventricular systolic pressure greater than 60 mmHg and recurrence of the ventricular septal defect. The combination of ventricular tachycardia and a poor haemodynamic result is associated with a mortality rate of 33 p. 100. The functional status of the patient, conduction defects and the surgical technique used were not predictive of ventricular tachycardia. The detection of a ventricular arrhythmia on the resting ECG, and, particularly, on Holter monitoring, and the induction of ventricular tachycardia by ventricular stimulation should lead to treatment against malignant ventricular arrhythmias and sudden death. The choice of anti-arrhythmic agent may be guided by endocavitary stimulation techniques to assess its efficacy.
D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D011183:Postoperative Complications; D011379:Prognosis; D013610:Tachycardia / Q000209:etiology* / Q000503:physiopathology; D013771:Tetralogy of Fallot / Q000601:surgery; D013997:Time Factors
Tachycardies ventriculaires tardives après correction chirurgicale d'une cardiopathie congénitale. Incidence, sévérité et facteurs prédictifs.