Delayed onset of atrioventricular block after transcatheter closure of peri membranous ventricular septal defect recovered after surgical axplantation: A case report and review of literature

Author(s): Sarin Lekchuensakul, Vichai Benjacholamas, Pornthep Lertsapcharoen

Background: Atrioventricular block (AV block) is still a major concern following transcatheter closure of Ventricular Septal Defect (VSD) despite an improvement in post-procedural outcome in the current era. Late onset of AV block has rarely been reported thus no consensus on definite treatment options exists.

Case presentation: We report a case of delayed onset of AV block which occurred 3 years after transcatheter VSD closure in a 4-year-old boy with peri membranous VSD. The VSD size was 8 mm at the Left Ventricular (LV) opening and 4 mm at the Right Ventricular (RV) opening and aneurysmal-type Cocoon ventricular septal occluder 8-6/10 mm (the device has a central waist diameter at the distal site of 8 mm and at the proximal site of 6 mm with its length of 10 mm) was deployed without immediate post-procedural complication. The ECG remained in normal sinus rhythm throughout the regular follow-up period. He developed exercise intolerance 3 years later and ECG showed a new onset of complete AV block with a junctional rate of 60 beats/minute. Surgical removal of the device with VSD closure was successfully performed and resulted in a restoration of sinus rhythm within 3 months after the operation. The patient had regained normal functional capacity and a good exercise tolerance without the need for permanent pacemaker implantation.

Conclusion: Progressive perinodal inflammation can damage the conduction system and result in the late onset of AV block. Surgical removal of the device can be a possible treatment option although permanent pacemaker implantation is frequently required. Comprehensive long-term follow-up focusing on conduction system disturbance is crucial after transcatheter closure of VSD.