Heart rhythm disorders, quality of life of children operated on for ventricular septal defect depending on the age of correction
Authors: Iushchenko A , Kaladze Nikolay KN 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Surgical treatment of a ventricular septal defect (VSD) should be carried out before the onset of high pulmonary hypertension. It is known, that with large defects of the ventricular septal, irreversible changes in the vessels of the pulmonary circulation (Eisenmenger"s syndrome) can develop from the age of 2.
The aim of the study was to study cardiac arrhythmias (HRV) and quality of life (QOL) in children operated on for VSD, depending on the age of correction.
Material and methods. We examined 74 children, operated on for VSD from the age of 3 to 18 years. The median age was 9 [6; 14] years, surgery age - 1 [0.5; 2] year, postoperative period - 6 [4; 11] years. Children were divided into 2 groups: group 1 consisted of 54 children operated on up to the age of 2, group 2 - 20 children operated on over 2 years of age. The diagnostic program included electrocardiogram (ECG), Holter ECG monitoring, and quality of life assessment using the cardiological module of the PEDsQL 3.0 questionnaire. Some authors regard a mark below 70 points as impaired QOL. The Mann-Whitney U-test was used to assess the significance of differences between the groups in terms of quantitative characteristics, and Fisher"s exact test or Pearson"s χ2 test for qualitative (nominal, ordinal) indicators. Normality of distribution was checked using the Shapiro-Wilk test. Significant changes in indicators were considered those at which the probability of the null hypothesis was p &lt;0.05. To assess the correlation relationships, Spearman"s rank correlation coefficient was used. Correlations were considered significant at p &lt;0.05.
Results. In group 1, HRV were found in 47 (87%), in group 2 - in 9 (45%) children (p˂0.001, OR = 0.122, 95% CI: 0.037-0.399). In children operated on before 2 years of age, such rhythm disturbances as complete block of the right bundle branch (p = 0.031, OR = 0.238, 95% CI: 0.062-0.909) and AV block of various degrees of gradation (p = 0.015, OR = 0.672, 95% CI: 0.564-0.801). The QOL of children according to the overall score according to the assessments of children: in group 1 - 84.9 [61.5; 89.5] points, in group 2 - 60.7 ± 13.5 points (p = 0.001), according to parents" estimates: in group 1 - 69.7 [51.2; 88.2] points, in group 2 - 50.5 ± 19.1 points (p = 0.002); according to cardiac symptoms according to the estimates of children: in group 1 - 87.5 [73.2; 89] points, in group 2 - 71.1 ± 14.2 points (p = 0.007), according to parents" estimates: in group 1 - 75 [68; 82] points, in group 2 - 55.8 ± 16.6 points (p˂0.001). Inverse correlations of average strength were obtained between the age of surgery and the QOL in terms of the overall score and cardiac symptoms as assessed by children and parents (p˂0.05).
Conclusions. Surgical treatment of a VSD before the age of 2 years is associated with the occurrence of conditional disorders and a higher QOL, according to the estimates of children and parents.