Early complete atrioventricular block after percutaneous closure of a perimembranous ventricular septal defect with a Nit-Occlud (®) Lê VSD coil

Abstract

A 7-year-old female presented with a 6- to 7-mm restrictive perimembranous ventricular septal defect with posterior extension, moderate dilatation of the left atrium and left ventricle and moderate tricuspid regurgitation. Diagnostic cardiac catheterization and transoesophageal echocardiography (TEE) were performed, and a left to right shunt (oximetric shunt of 12.6%) at the ventricular level was found with a QP/Qs of 1.83. Pressure assessment revealed moderate hyperkinetic pulmonary hypertension and pulmonary vascular resistances of 2.9 WU·m2. A Nit-Occlud® Lê VSD was implanted. Immediate control angiography and TEE revealed a residual VSD of 2,5 mm and an increase in the degree of tricuspid regurgitation that increased to grade II-III/IV.Twelve hours after device implantation, the EKG revealed a complete AV block. Based on the residual shunt, tricuspid regurgitation, and the cAVB, surgical explantation of the device was decided. The device was removed, and the VSD was closed with a patch. Twenty-four hours after the surgery and still on corticosteroid treatment, the patient recovered sinus rhythm with a normal PR interval.The appearance of a complete AV block hours after the procedure was likely related with an inflammatory process related to the device. cAVB can be a serious complication of perimembranous VSD closure that to date seems possible with any perimembranous VSD device, as the anatomy of the conducting tissue is highly variable. This risk should be considered in the selection of candidates for this procedure.