title: Atrioventricular block subsequent to intraoperative device closure atrial septal defect with transthoracic minimal invasion; a rare and serious complication.
abstract: OBJECTIVE
  Atrioventricular block (AVB) is a infrequent and serious complication after percutaneous ASD closure. In this study, we report on the incidence of AVB associated with intraoperative device closure of the ASD with transthoracic minimal invasion, and the outcomes of this complication in our center.
  
  
  METHODS
  Between May 2006 and January 2011, a total of 213 secundum-type ASD patients were accepted in our hospital for intraoperative and transthoracic device closure with a domestic occluder. All patients were assessed by real-time transthoracic echocardiography (TTE) and electrocardiograph (ECG).
  
  
  RESULTS
  All patients were occluded successfully under this approach. Immediate postprocedure third-degree AVB was observed in two patients. Since heart rates were in the range of about 50 to 55 beats per minute, no intervention was needed except for close observation for one patient. Another patient who recovered sinus rhythm intermittently during the operation was fitted with a temporary pacemaker. Approximately one week following glucocorticoid treatment, the AVB resolved spontaneously in these two patients. Mobitz type II AVB occurred in three patients during the procedure. Two patients developed post-operative cardiac arrest and were rescued successfully with cardiopulmonary resuscitation. One other patient changed to Mobitz type I AVB after three days. During the follow-up period, which ranged from six months to five years, no further occurrence of AVB was found.
  
  
  CONCLUSIONS
  Intraoperative and transthoracic device closure of secundum ASDs with domestic occluder resulted in excellent closure rate. AVB is an infrequent but serious complication during and after device closure of a secundum ASD. AVB is a complication that warrants greater attention and long-term follow-up.
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P. R. China. chenqiang2228@hotmail.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: Dao-Zhong
authors.initials: DZ
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 / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D055989:Septal Occluder Device; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult