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 device closure of atrial septal defects in patients aged 40 years and older

Objective To evaluate the safety and effect of transcatheter device closure in ostium secundum atrial septal defects (ASD II) in patients aged 40 years and older Methods Retrospective single-centre study concerning 47 consecutive ASD transcatheter occlusion procedures performed between January 1999 and December 2008 Electrocardiography, echocardiography and clinical assessments of the patients were conducted pre- and post-intervention and at follow-up Results Of the 130 patients who were referred for interventional ASD closure, 47 were 40 years and older and all of them actually had the device inserted There were no major complications during the intervention Mean follow-up time was 15 15 months During follow-up, three patients needed surgical reintervention because of device embohsation (n=2) or dislocation (n=1) Of the patients with severe right ventricular (RV) dilatation, more than half (58%) had no or mild dilatation at last follow-up Reduction of RV dilatation was not related to age Pulmonary hypertension was present in 63% before the procedure and was reduced to 38% at follow-up NYHA class improved in all age groups, also in patients over 60 years of age In two of the three patients who died during follow-up, no cause of death could be established, but both had responded well to treatment regarding the echocardiographic and clinical findings Conclusion Transcatheter device closure of ASD is a successful and effective treatment, also for patients aged 40 years and older Patients showed regression of right ventricular enlargement and an improvement in functional class (Neth Heart J 2010,18 537-42