Background:
The incidence of post-operative complete heart block (CHB) in patients undergoing intra-cardiac repair for congenital heart disease in Ghana has not been reported. This information is important in pre-operative counseling of patients and parents and facilitates the process of obtaining informed consent for patients undergoing such repairs.

Objectives:
This study was undertaken to determine: 1) the incidence of permanent post-operative CHB in the setting of congenital heart disease, 2) the intra-cardiac anatomic risk factors in such patients and 3) the significance of the pacemaker in terms of morbidity after intra-cardiac repair.

Design:
This is a retrospective descriptive study.

Setting:
The National Cardiothoracic Centre (NCTC), Korle Bu Teaching Hospital, Accra, Ghana.

Method:
This was a review of patients who had intra-cardiac repair of congenital heart disease known to predispose to post-operative complete heart block from January 1992 to November 2008. Analysis of results was performed using the SPSS program.

Results:
Six patients out of 216 (2.8%) developed permanent post-operative CHB. All underwent closure of a large perimembranous ventricular septal defect (VSD) either as an isolated defect or in the setting of tetralogy of Fallot. The dominant morbidity relating to the implanted device was parental concern regarding the financial implications of future multiple surgeries to replace a depleted pulse generator.

Conclusion:
Permanent post-operative CHB occurred in 2.8% of patients undergoing intracardiac repair for congenital heart disease on the ventricular septum. The dominant anatomic risk factor was a large perimembranous VSD. Pacemaker-associated morbidity is acceptable in this setting.