Lu Jin, Lian Xingchen, Wen Ping, Liu Yuhang
Department of Cardiovascular Surgery, Dalian Women and Children's Medical Group, Dalian, China.
Front Cardiovasc Med. 2023 Jul 25;10:1226139. doi: 10.3389/fcvm.2023.1226139. eCollection 2023.
Long-term delayed complete atrioventricular block (CAVB) is a serious complication of ventricular septal defect (VSD) closure treatment. Thus, cardiac surgeons have made significant efforts to explore its causes and reduce its incidence. In recent years, minimally invasive transthoracic closure (MITC) of VSD has been used widely and successfully in China as it is easy to repeat, ensures individualized closure, and can be debugged repeatedly. Theoretically, the possibility of the recurrence of CAVB is lower than that with transcatheter closure. Although the incidence of CAVB after MITC of VSD is inevitable, long-term delayed CAVB has rarely been reported.
Herein, we report a case of delayed CAVB that occurred 2 years and 5 months after performing MITC of a perimembranous VSD. The cardiac rhythm recovered after the occluder was removed surgically.
The findings of our case report emphasize that since delayed CAVB may occur in the long term after MITC of VSD, the safety of MITC of VSD should be reassessed, the indications for MITC should be strictly followed, and long-term follow-up, including lifelong follow-up, is recommended for patients postoperatively. In addition, the occluder should be removed surgically in patients with CAVB as it may restore normal heart rhythm.
长期延迟性完全性房室传导阻滞（CAVB）是室间隔缺损（VSD）封堵治疗的严重并发症。因此，心脏外科医生已做出巨大努力来探究其病因并降低其发生率。近年来，VSD微创经胸封堵术（MITC）在中国已得到广泛且成功的应用，因为它易于重复操作，能确保个体化封堵，且可反复调试。从理论上讲，CAVB复发的可能性低于经导管封堵术。虽然VSD的MITC术后CAVB的发生率不可避免，但长期延迟性CAVB鲜有报道。
在此，我们报告1例在进行膜周部VSD的MITC术后2年零5个月发生延迟性CAVB的病例。手术取出封堵器后心律恢复。
我们的病例报告结果强调，由于VSD的MITC术后可能长期发生延迟性CAVB，应重新评估VSD的MITC安全性，严格遵循MITC的适应证，建议对术后患者进行长期随访，包括终身随访。此外，对于发生CAVB的患者应手术取出封堵器，因为这可能恢复正常心律。
