CHRONIC POSTOPERATIVE HEART BLOCK IN CHILDREN

The course and management of 13 children with chronic postoperative heart block are reviewed. Ten patients were managed by medical means after an initial period of temporary pacemaker control and 3 by permanent pacemaker implantation. Of the former group, 3 died within five months of surgery, and all had significant residual cardiac lesions. The condition of the 7 survivors is satisfactory eight months to nine years after operation. Cardiac catheterization was performed postoperatively in 4 of the 7 survivors and in 3 demonstrated an adequate cardiac output that was maintained by an increase in stroke volume. Of the 3 patients managed by permanent pacemaker implantation, 1 died six months postoperatively, the second is living and well, and the third experienced multiple pacemaker complications. Because of these complications, the pacemaker was removed and the child remains asymptomatic. The results of this study suggest that, in selected patients, chronic postoperative heart block may be successfully managed without the use of a permanent pacemaker. © 1968.