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Late complete atriovenous block after percutaneous closure of a perimembranous ventricular septal defect
Gianfranco Butera1, Chessa Massimo, Carminati Mario
1Pediatric Cardiology, Policlinico San Donato, San Donato Milanese, Italy. gianfra.but@lycos.com
Insights
Percutaneous closure of perimembranous ventricular septal defects (VSD) can lead to delayed complete atrioventricular block. Two young patients required pacemaker implantation months after VSD device closure.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Percutaneous closure is an alternative to surgical repair for perimembranous ventricular septal defects (VSD).
- Complete atrioventricular (AV) block is a known complication, particularly in the early postoperative period.
Observation:
- Two pediatric patients (2.5 and 4 years old) underwent percutaneous closure of a perimembranous VSD using an eccentric occluder device.
- Complete AV block developed 4 and 12 months post-procedure in these patients.
Findings:
- One patient presented with syncope, while the other was asymptomatic despite developing complete AV block.
- Both patients required endocardial ventricular pacemaker implantation due to the delayed complication.
Implications:
- This case series highlights the potential for late-onset complete AV block following perimembranous VSD percutaneous closure with eccentric devices.
- Long-term cardiac monitoring is crucial for pediatric patients after VSD device closure to detect delayed arrhythmias.
- Further research is warranted to understand the mechanisms and optimize device selection to mitigate the risk of AV block.
Abstract:
Percutaneous closure of a perimembranous ventricular septal defect (VSD) is an alternative to surgical closure. Complications include arrhythmias and in particular early postoperative complete atrioventricular (AV) block. We report the cases of two patients, aged 2.5 and 4 years, treated with an eccentric VSD occluder device whom developed complete AV block 4 and 12 months after the procedure. The first patient experienced syncope, while the second one was completely asymptomatic. Both subjects underwent endocardial ventricular pacemaker implantation.
