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J Thorac Cardiovasc Surg 2008;136:1223-1228
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Complete heart block associated with device closure of perimembranous ventricular septal defects

Cardiac Diagnostic and Interventional Unit, the Labatt Family Heart Centre, the Hospital for Sick Children, the University of Toronto School of Medicine, Toronto, Ontario, Canada

Received for publication November 24, 2007; revisions received January 31, 2008; accepted for publication February 19, 2008.

^_* Address for reprints: Kyong-Jin Lee, MD, the Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. (Email: kyong-jin.lee{at}sickkids.ca).

Objective: The development of the Amplatzer Membranous VSD Occluder (AGA Medical Corp, Plymouth, Minn) for closure of the perimembranous ventricular septal defect has ameliorated many of the technical difficulties of previous devices. Application of this new technology requires comparative evaluation with the current standard of surgical repair. We report our experience of complete heart block associated with device closure of a large perimembranous ventricular septal defect with unequivocal indications for intervention.

Methods: We performed a retrospective review of 20 patients between January 2003 and August 2005 who underwent perimembranous ventricular septal defect device closure, 18 with hemodynamically large shunts meeting the surgical criteria for intervention. The median age was 1.6 years (range, 0.5–16.2 years), and the median weight was 9.7 kg (range, 6.2–43 kg).

Results: Acute complete shunt occlusion was achieved in all patients. There were no acute procedural complications. The median follow-up time was 23.1 months (range, 1–37.8 months). Four (22%) had complete heart block at 17 days, 4.2 months, 8.8 months, and 37.5 months after implantation, respectively. No risk factors were identified for development of complete heart block, including age, weight, trisomy 21, preceding conduction abnormalities, perimembranous ventricular septal defect size related to body surface area or device size, and progressive device flattening.

Conclusions: Device closure of large perimembranous ventricular septal defects in infants and children with the Amplatzer Membranous VSD Occluder resulted in excellent closure rates but an unacceptably high rate of complete heart block.

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