Bundle-Branch Block, Heart Septal Defects, Ventricular
Conditions
Keywords
Right bundle branch block, Ventricular septal defect, Echocardiography, MRI, Exercise testing
Brief summary
The most common congenital heart disease is the ventricular septal defect, and after surgical closure of a such defect, an arrythmia called the right bundle branch block, is very frequent. Therefore the aim of this study is to investigate if this group of patients has inferior outcomes compared to the group without this arrythmia after surgical closure and compared to a group of healthy control subjects. All patients will be undergoing 1. exercise testing, 2. echocardiography, 3. echocardiography during exercise, and 4. MRI. The perspective is the ability to point out a group of patients with a possible need of further intervention, and additionally to increase the awareness of protecting the electrical system of the heart during the operation.
Detailed description
Right bundle branch block is an exceedingly frequent complication in heart surgery, and especially in patients who have undergone surgical closure of a ventricular septal defect which is the most common congenital heart disease. How this bundle branch block effects the right ventricle of the heart on a long-term basis for this group of patients, is still unknown. As a part of a PhD-study we therefore will try to illustrate this by echocardiography, MRI, exercise testing and other investigations 15 to 20 years after the surgical procedure. The study population thus consists of three different groups: 1. Patients whom undergone surgical closure of ventricular septal defect without postoperative right bundle branch block, 2. VSD-operated patients with right bundle branch block and 3. Healthy controls with no significant medical issues matched on age and sex. By carrying out the tests mentioned the right ventricles systolic function, diastolic function, the patients maximal exercise capacity and a lot of other parameters will be evaluated in the three groups of patients and compared amongst each other. The perspective therefore is the ability to point out a specific group of patients with an inferior outcome and with a possible need for further intervention. An additional perspective is to increase the awareness of protecting the bundle branch during the operation.
Interventions
PROCEDUREEchocardiography at rest
Dimensions of all 4 chambers, inspiratory collapse, and gradient over the tricuspid valve is measured. Tricuspid Annulus Plane Systolic Excursion(TAPSE) and Tricuspid Annular peak Systolic Motion(TASM) is measured as well.
PROCEDUREEchocardiography during exercise
TASM is measured during exercise along with pulse measurements to evaluate the force-frequency-relation.
PROCEDUREMRI at rest
Dimensions of all 4 chambers are measured at end-systole and end-diastole. Blood flow measurements through the aortic and the pulmonary valve are made as well. No use of contrast.
PROCEDUREExercise testing
Maximal oxygen consumption is measured during on a bicycle. Prior to the test a spirometry is performed to rull out potential differences in pulmonary function between the cohorts. During the test pulse, blood pressure, saturation, and EKG are monitored. Ventilatory volume, oxygen consumption and carbon dioxide excretion are measured. Anaerobic threshold is calculated at the end of the test.
Sponsors
Aarhus University Hospital Skejby
University of Aarhus
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Operated for VSD in the period from 1990 to 1995 on Aarhus University Hospital Skejby
Exclusion criteria
* No chart to be found * No EKG to be found * Known bundle branch block prior to the surgery * Other arrythmias * Use of ventriculotomy * Other disease than VSD * Pacemaker or other metallic implants * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Systolic function at rest measured by echocardiography | All patients are tested only once about 20 years post to surgery | Dimensions of all 4 chambers, inspiratory collapse, and gradient over the tricuspidale valve is measured. Tricuspid Annulus Plane Systolic Excursion(TAPSE) and Tricuspid Annular peak Systolic Motion(TASM) is measured as well. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Maximal oxygen consumption during exercise | All patients are tested only once about 20 years post to surgery | Maximal oxygen consumption is measured during on a bicycle. Prior to the test a spirometry is performed to rull out potentiel diffenrences in pulmonary function between the cohorts. During the test pulse, blood pressure, saturation, and EKG are monitored. Ventilatory volume, oxygen consumption and carbondioxide excretion are measured. Anaerobic threshold is calculated at the end of the test. |
| Force-frequency-relation during exercise | All patients are tested only once about 20 years post to surgery | TASM is measured during exercise along with pulse measurements to evaluate the force-frequency-relation. |
| Diastolic function at rest measured by MRI | All patients are tested only once about 20 years post to surgery | Dimensions of all 4 chambers are measured at end-systole and end-diastole. Blood flow measurements through the aortic and the pulmonary valve are made as well. No use of contrast. |
| Diastolic function at rest measured by echocardiography | All patients are tested only once about 20 years post to surgery | Dimensions of all 4 chambers, inspiratory collapse, and gradient over the tricuspidale valve is measured. Tricuspid Annulus Plane Systolic Excursion(TAPSE) and Tricuspid Annular peak Systolic Motion(TASM) is measured as well. |
| Systolic function at rest measured by MRI | All patients are tested only once about 20 years post to surgery | Dimensions of all 4 chambers are measured at end-systole and end-diastole. Blood flow measurements through the aortic and the pulmonary valve are made as well. No use of contrast. |
Countries
Denmark
Outcome results
None listed