Transient complete right bundle branch block following right heart catheterization in children – a report of two cases

Introduction

Right bundle branch block (RBBB) in children is usually acquired following cardiac operations. Other causes include congenital heart defects (e.g. primum atrial septal defect (ASD), Ebstein’s anomaly) [1–3]. It can be a permanent disorder, usually after cardiac procedures, or it may have a transient character (tRBBB). Transient right bundle branch block is very rare in children and can occur for example as a response to blunt chest trauma [4].
We report 2 cases of complete transient RBBB that were associated with right heart catheterizations, one after pulmonary balloon valvuloplasty and the second one during the Rashkind procedure.

Case reports

Case 1

A 6-month-old boy with pulmonary valve stenosis (PS) was treated with balloon valvuloplasty. The treatment managed to decrease the invasive peak systolic pressure gradient between the right ventricle (RV) and pulmonary artery (PA) from 55 mm Hg to 16 mm Hg. No complications were observed during or after the procedure. Routine ECG performed before the treatment showed normal sinus rhythm, narrow QRS complexes, and right heart axis. Follow up 12-lead ECG performed 24 h after the procedure showed sinus rhythm, 125/min, the QRS prolongation to 100 ms, with typical RBBB morphology, allowing us to diagnose complete RBBB (Figures 1 A, B). 24-hour Holter ECG monitoring was performed, showing sinus rhythm, average HR 130/min and no arrhythmia. The patient was in an excellent clinical condition, showing no signs of distress or heart failure, with a heart rate of 100–150/min. No treatment was administered. In the 12-lead ECG performed 72 h after the procedure (Figures 1C, D) the RBBB had resolved. At 3-month follow-up there was no recurrence of the RBBB in the ECG.

Case 2

A 4-day-old male newborn diagnosed with a complex transposition of the great arteries (d-TGA), ventricular septal defect (VSD) and pulmonary artery stenosis underwent the Rashkind procedure due to the restrictive flow through the interatrial septum. The patient was in a severe general condition before the procedure, with blood oxygenation around 70–75% and significant dyspnea. His ECG showed normal sinus rhythm and narrow QRS complexes. At the beginning of the procedure during the attempt to forward the catheter through the ASD it was unintentionally placed in the right ventricle, and after that there was an abrupt change in the ECG pattern. We observed widening of the QRS...


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