Armaghane Danesh Bimonthly Journal (Jul 2024)
A Mid-term Study of ECG in Patients with Tetralogy of Fallot After open Heart Surgery in a Five-year Period in the Pediatric Heart Surgery Center of Fars Province
Abstract
Background & aim: Tetralogy of Fallot is the most common congenital cyanotic disease and the severity of the clinical symptoms of the disease depends on the degree of right ventricular outflow tract stenosis, although most infants have some degree of cyanosis. Surgical treatment of the disease has resulted in a very good survival rate, although problems such as obstruction and narrowing of the right ventricular blood flow, backflow of blood through the pulmonary valve, and ventricular arrhythmias may occur over time. Therefore, the purpose of the present study was to determine and evaluate the mid-term ECG of patients with tetralogy of Fallot after open heart surgery in a five-year period at the pediatric heart surgery center of Fars province. Methods: The present retrospective cross-sectional descriptive study was conducted between 2015 to 2016. The records of 116 patients with tetralogy of Fallot who underwent reconstructive surgery were reviewed. Six patients died during surgery and immediately after surgery. The electrocardiogram of the patients, which was taken with a time interval of 3 hours to 3 days after the surgery, was analyzed in terms of PR interval duration, QRS complex duration, QT interval duration, and ST segment changes, and the relationship of ECG changes with Reported age and sex. Moreover, the types of arrhythmia that occurred in this period of time were analyzed. The collected data were analyzed using chi square and Fisher statistical tests. Results: Prolongation of PR interval was observed in 6 patients (5.5%) and first degree heart block was observed in 38 patients (34.5%). Prolonged QRS complex time was observed in 40 patients (36.4%) and prolonged QTC interval was observed in 58 patients (52.7%). ST segment was unchanged in 80.9%, and ST segment elevation was seen in 9 patients (8.2%) and ST segment lowering in 12 patients (10.9%). There was no significant relationship between the changes mentioned above in the patients' ECG and age and gender (p<0.05). 80 patients had sinus rhythm and 30 patients had arrhythmia or non-sinus rhythm. The most common arrhythmia seen in these patients was junctional ectopic rhythm in 8 patients (7.27%) and the second most common arrhythmia was first degree heart block in 6 patients. (5.45% of patients) and RBBB with sinus rhythm was seen in 40 patients (36.4%). Conclusion: With the investigations carried out in the previous studies as well as the present study, the need for continuous cardiac monitoring and investigation of any cardiac irregularity during the period after heart surgery in children is very important. With continuous monitoring and follow-up and faster treatment of any cardiac irregularity, the occurrence of unfortunate events (sudden death without a cause) can be prevented.
