Atrioventricular block of intraoperative device closure perimembranous ventricular septal defects; a serious complication

<p>Abstract</p> <p>Background</p> <p>Atrioventricular block (AVB) is a well-reported complication after closure of perimembranous ventricular septal defects (VSDs). To report the occurrence of AVB either during or following closure of perimembranous VSDs using a novel "hybrid" method involving a minimal inferior median incision and of intraoperative device closure of the perimembranous VSDs.</p> <p>Methods</p> <p>Between January 2009 and January 2011, patients diagnosed with perimembranous VSDs eligible for intraoperative device closure with a domestic occluder were identified. All patients were assessed by real-time transesophageal echocardiography (TEE) and electrocardiography.</p> <p>Results</p> <p>Of the 97 included patients, 94 were successfully occluded using this approach. Complete AVB occurred in only one case and one case of Mobitz type II AVB was diagnosed intraoperatively. In both patients, the procedure was aborted and the AVBs quickly resolved. Glucocorticosteroids were administered to another two patients who developed Mobitz type II AVB intraoperatively. Those two patients converted to Mobitz type I AVB 3 days and 5 days postsurgically. During the follow-up period (range, 6-24 months), one patient developed complete AVB 1 week following device insertion. Surgical device removal was followed by a rapid and complete recovery of atrioventricular conduction.</p> <p>Conclusions</p> <p>Intraoperative device closure of perimembranous VSDs with a domestic occluder resulted in excellent closure rates; however, AVB is a serious complication that can occur either during or any time after device closure of perimembranous VSDs. The technique described herein may reduce the incidence of perioperative AVB complications. Surgeons are encouraged to closely monitor all patients postsurgically to ensure AVB does not occur in their patients. Additional long-term data to better identify the prevalence and risk factors for AVB in treated patients are needed.</p

Transcatheter pulmonary valve implantation in native pulmonary outflow tract using the Edwards SAPIEN&trade; transcatheter heart valve.

Percutaneous pulmonary valve implantation (PPVI) is now an accepted alternative option to conventional surgery for patients with dysfunctional conduits between the right ventricle and pulmonary artery. PPVI will reduce the total number of repeat operations in such patients. However, surgery remains the primary option in postoperative tetralogy of Fallot patients with severe pulmonary regurgitation who underwent transannular patch reconstruction of their right ventricular outflow tract (RVOT). Traditionally, an RVOT patch is considered a relative contraindication to PPVI, however, in selected patients PPVI was successfully performed. We report the case of a 12-year-old patient after neonatal repair of tetralogy of Fallot and pulmonary atresia, who developed advanced liver disease and severe pulmonary regurgitation. In this patient, the risk for surgical valve replacement was considered too high and he was treated with percutaneous implantation of the Edwards SAPIEN\u2122 transcatheter heart valve