Całkowity blok prawej odnogi pęczka Hisa u dziecka po chirurgicznej korekcji ubytku przegrody międzykomorowej

*Anna Piórecka-Makuła, Tomasz Książczyk

Summary
Ventricle septal defect (VSD) is the most common type of congenital heart defect in children (CHD), occurs approximately in 2.56/1000 live births and accounts for around 15-20% of all CHD. The authors present a case of male newborn diagnosed with VSD in the neonatal period. The child was asymptomatic and in a good general condition in the first months of life. At the age of 5 months syndromes of heart failure were present: tachypnoe with use of accessory breathing muscles, enlarged liver, elevated serum concentration of NTproBNP, enlargement of heart size and increased pulmonary blood flow in chest X-Ray and enlargement of the left atrium and left ventricle in echocardiography. The patient was qualified for the surgical closure of VSD. Surgery was performed at the age of 6 months. In postsurgical assessment the resolution of clinical symptoms, complete closure of the defect and complete right bundle branch block pattern in the ECG with no hemodynamic consequences and no rhythm disorders were found. Complete RBBB is very common sequele of the surgical correction of the VSD in infants. Usually it has no negative hemodynamic effect but in the recent studies with use of very sensitive echocardiographic tools (tissue dopler, speckle tracking) decreased right ventricle function and ventricles dyssynchrony was found in patients with complete RBBB after surgical VSD closure.

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