Abstract
Background
Transcatheter closure is an effective approach for perimembranous ventricular septal defects (PMVSD). However, atrioventricular blocks (AVB) emerged possibly due to the close proximity of the PMVSD to the conduction system, but concern for the complication was not adequately emphasized. In this study, we report the incidence of AVBs, in and after transcatheter closure of a PMVSD, and the outcome of the complication in our center.
Methods
One hundred and sixty‐eight PMVSD patients were accepted for transcatheter closure with Amplazter PMVSD occluder (AGA Medical, Plymouth, Minn., USA). The procedure was discontinued when a second‐ or third‐degree AVB occurred. A steroid was administered to all patients who developed AVBs. Temporary pacemakers were inserted in patients who developed a complete AVB or Mobitz type II AVB during or after the procedure.
Results
During the follow‐up period of 6–24 mo (mean 10.6 ± 3.9), the incidence of AVBs occurring during or after transcatheter closure of PMVSD was 3.5%. The AVB disappeared quickly after discontinuing the procedure in patients who developed AVBs during the procedure, whereas the AVBs disappeared between 2 and 21 d (mean 8.0 ± 8.8) in the patients who developed AVBs after the procedure. However, complete right bundle branch block (CRBBB) was observed, and a transient complete AVB emerged after 8 mo in 1 case, incomplete right bundle branch block (IRBBB) in 1 case, and CRBBB and left anterior hemiblock (LAH) in 1 case.
Conclusions
The AVB is a serious complication during and after transcathter closure of PMVSD. More attention should be paid to the complication, and multicentres are required to monitor the complication. Copyright © 2008 Wiley Periodicals, Inc.
Keywords: atrioventricular block, catheterization, ventricular septal defect, complication
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References
- 1. Hijazi ZM, Hakim F, Haweleh AA, Madani A, Tarawna W, et al.: Catheter closure of perimembranous ventricular septal defects using the new Amplatze rmembranous VSD occluder: initial clinical experience. Catheter Cardiovasc Interv 2002; 56(4): 508–515. [DOI] [PubMed] [Google Scholar]
- 2. Bass JL, Kalra GS, Arora R, Masura J, Gavora P, et al.: Initial human experience with the Amplatzer perimembranous ventricular septal occluder device. Catheter Cardiovasc Interv 2003; 58(2): 238–245. [DOI] [PubMed] [Google Scholar]
- 3. Thanopoulos BD, Tsaousis GS, Karanasios E, Eleftherakis NG, Paphitis C: Transcatheter closure of perimembranous ventricular septal defects with the Amplatzer asymmetric ventricular septal defect occluder: preliminary experience in children. Heart 2003; 89(8): 918–922. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Hijazi ZM: Device closure of ventricular septal defects. Catheter Cardiovasc Interv 2003; 60(1): 107–114. [DOI] [PubMed] [Google Scholar]
- 5. Pedra CA, Pedra SR, Esteves CA, Pontes SC Jr, Braga SL, et al.: Percutaneous closure of perimembranous ventricular septal defects with the Amplatzer device: technical and morphological considerations. Catheter Cardiovasc Interv 2004; 61(3): 403–410. [DOI] [PubMed] [Google Scholar]
- 6. Yip WC, Zimmerman F, Hijazi ZM: Heart block and empirical therapy after transcatheter closure of perimembranous ventricular septal defect. Catheter Cardiovasc Interv 2005; 66(3): 436–441. [DOI] [PubMed] [Google Scholar]
- 7. Walsh MA, Bialkowski J, Szkutnik M, Pawelec‐Wojtalik M, Bobkowski W, et al.: Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects. Heart 2006; 92(9): 1295–1297. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Pedra CA, Pedra SR, Esteves CA, Pontes SC Jr, Braga SL, et al.: Percutaneous closure of perimembranous ventricular septal defects with the Amplatzer device: technical and morphological considerations. Catheter Cardiovasc Interv 2004; 61(3): 403–410. [DOI] [PubMed] [Google Scholar]
- 9. Carminati M, Butera G, Chessa M, Drago M, Negura D, et al.: Transcatheter closure of congenital ventricular septal defect with Amplatzer septal occluders. Am J Cardiol 2005; 96(12A): 52L–58L. [DOI] [PubMed] [Google Scholar]
- 10. Thanopoulos BD, Tsaousis GS, Konstadopoulou GN, Zarayelyan AG: Transcatheter closure of muscular ventricular septal defects with the amplatzer ventricular septal defect occluder: initial clinical applications in children. J Am Coll Cardiol 1999; 33(5): 1395–1399. [DOI] [PubMed] [Google Scholar]
- 11. Weindling SN, Saul JP, Gamble WJ, Mayer JE, Wessel D, et al.: Duration of complete atrioventricular block after congenital heart disease surgery. Am J Cardiol 199815; 82(4): 525–527. [DOI] [PubMed] [Google Scholar]
- 12. Arora R, Trehan V, Kumar A, Kalra GS, Nigam M: Transcatheter closure of congenital ventricular septal defects: experience with various devices. J Interv Cardiol 2003; 16(1): 83–91. [DOI] [PubMed] [Google Scholar]
- 13. Ho SY, McCarthy KP, Rigby ML: Morphology of perimembra‐ nous ventricular septal defects: implications for transcatheter device closure. J Interv Cardiol 2004; 17(2): 99–108. [DOI] [PubMed] [Google Scholar]
- 14. Butera G, Massimo C, Mario C: Late complete atriovenous block after percutaneous closure of a perimembranous ventricular septal defect. Catheter Cardiovasc Interv 2006; 67(6): 938–941. [DOI] [PubMed] [Google Scholar]
- 15. Breur JM, Visser GH, Kruize AA, Stoutenbeek P, Meijboom EJ: Treatment of fetal heart block with maternal steroid therapy: case report and review of the literature. Ultrasound Obstet Gynecol 2004; 24(4): 467–472. [DOI] [PubMed] [Google Scholar]
- 16. Andersen HO, de Leval MR, Tsang VT, Elliott MJ, Anderson RH, et al.: Is complete heart block after surgical closure of ventricular septum defects still an issue? Ann Thorac Surg 2006; 82(3): 956–957. [DOI] [PubMed] [Google Scholar]