临床与实验心脏病学
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Atrioventricular Block Unveiled during Ventricular Septal Defect Closure-A Serial Case Report

Pratiwi Indrihapsari*, Valerinna Yogibuana

Background: The transcatheter ventricular septal defect procedure is a complex intervention that poses potential complications, including complete heart block. We present here two cases of patients who developed AV block during the closure of VSD and recovered with steroids and atropine.

Case presentation: Peri membranous VSD was found in a 19-year-old military recruit. A baseline 12-lead EKG showed sinus rhythm and no conduction delays. Echocardiography revealed a 6 mm-9 mm peri membranous VSD. Then the VSD was closed with a VSD occluder no 10-8. ECG monitor and echocardiography showed a complete atrioventricular block during the procedure. Fortunately, atropine and methylprednisolone overcame this. Recurrent atrioventricular block and VSD were not found after the procedure. Routine screening revealed peri membranous VSD in a 33-year-old man. His 12-lead EKG was normal, but an echocardiogram showed a 3 mm-5 mm peri membranous VSD. Using VSD occluder no 10-8 closed the VSD trans catheterally. The hemodynamic monitor and echocardiography showed a total atrioventricular block during the procedure. Luckily, atropine and methylprednisolone solved his heart rhythm. The device was put in despite this issue. The procedure left no residual VSD or atrioventricular block.

Conclusion: During the transcatheter closure of ventricular septal defects, there is a potential risk of atrioventricular block. This can occur due to mechanical trauma or compression caused by the delivery system or device. It is crucial to choose the appropriate device size to minimize the risk of this complication. Close heart rhythm monitoring is necessary during short-term and long-term follow-up periods.