title: Atrioventricular block of intraoperative device closure perimembranous ventricular septal defects; a serious complication.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29#, Gulou District, Fuzhou 350001, People's Republic of China. scottie98345@sohu.com
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.forename: Hua
authors.initials: H
authors.lastname: Cao
authors.forename: Gui-Can
authors.initials: GC
authors.lastname: Zhang
authors.forename: Liang-Wan
authors.initials: LW
authors.lastname: Chen
authors.forename: Qian-Zhen
authors.initials: QZ
authors.lastname: Li
authors.forename: Zhi-Huang
authors.initials: ZH
authors.lastname: Qiu
mesh_terms: D000293:Adolescent; D000328:Adult; D054537:Atrioventricular Block / Q000209:etiology / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D055989:Septal Occluder Device; D016896:Treatment Outcome; D055815:Young Adult