Аnalysis of preoperative and postoperative electrocardiogram in children with total anomalous pulmonary venous connection

Abstract

Introduction. TAPVC is a condition that requires diagnosis and surgical treatment in a short period of time. As the result of an absence of the direct connection between pulmonary veins and left atrium, systemic and pulmonary venous return drainage to the right heart with volume and pressure overload. At the same time, left heart preload is depending on atrial septal defect. The hemodynamic features of the TAPVC create conditions for abnormal spread of electric impulses, whereas necessity of surgical reconstruction on the atrial level — reasons for rhythm and conduction disturbance in postoperative period.Aim of the study: detection of specific EKG markers of TAPVC for differential diagnosis of critical conditions in children, analysis of basis preand postoperative EKG to determine EKG pattern in children with TAPVC, registration of EKG changing in early and late postoperative period to define the potential rhythm and conduction disturbance in patients with TAPVC.Materials and methods. The data of biventricular TAPVC patients were reviewed. We estimated characteristic of P, PQ, QRS, QT, rhythm and conduction disturbance and evaluated preand postoperative EKG data, with their comparison in 30 patients. Results. Preoperative EKG (9,3 ± 6,5 days) showed sinus rhythm in all cases, P wave was 62,6 ± 10,6 (40–80) msec, PQ — 104,1 ± 15 (80–160) msec, QRS — 64,3 ± 13,5 (40–100) msec, QT — 253,1 ± 29,5 (210–350) msec, electric axis of the heart — 130,9 ± 44,4 (-70 ± 185). Postoperative rhythm was sinus in 83,3 % cases, atrial ectopic — 13,3 %, AV node rhythm — 3,3 %. The comparison of preand postoperative EKG data showed significant (p < 0,05) difference in P, QT, and electric axis of the heart measurements. In late postoperative period we detected non-pathological differences in P, PQ, QRS, QT compared early posleoperative period, but sinus node dysfunction frequency was high in late postoperative period.Conclusion. There are no specific ECG markers in preoperative TAPVC patients. The standard EKG showed right heart volume and pressure overloud with positive changing of it after surgical correction of TAPVC. The early postoperative EKG did not showed “typical” rhythm and conduction disturbance after surgery at the atrial level, but patients require a long-time dynamic observation after TAPVC surgery because of higy frequency of sinus node dysfunction in late postoperative period.