Transcatheter closure of ventricular septal defects, which has been used extensively in recent years, has become a treatment of choice in selected patients. However, there is relatively limited experience with large VSD (>15 mm) and/or obviously preprocedural ECG abnormality in heart conduct system. The patient in this case is a 15-year-old male with 17 mm perimembranous ventricular septal defect (PVSD) accompanied with critical pulmonary valve stenosis (PS) and II II auriculo-ventricular block (AVB). Having denied prophylactic permanent pacemaker implantation and open chest operation repair, this patient later was performed percutaneous balloon pulmonary valvuloplasty (PBPV) and subsequently transcatheter closure of VSD with a special designed 24 mm modified Amplatzer perimembranous VSD occluder without obvious residual intracardiac shunting and residual pulmonary valve stenosis (after 2nd stage PBPV). Transient complete heart block and junctional escape rhythm were developed one day after procedure and recovered 7 days later. During 4-year follow-up, no sequela was revealed by regular and ambulatory ECG monitoring. Placement of device confirmed satisfactory and no residual intracardiac shunting or heart valves regurgitation was detected echocardiographically. We deduced that the II II AVB might be congential and stable in this case. In our opinion, transcatheter closure of large VSD (>15 mm) and/or obviously ECG abnormality in heart conduct system appears to be an alternative option for carefully selected patients who are not willing to undergo surgical repairs. However, prognosis should be strictly evaluated by long time and multi-centre follow-up.
- pulmonary valve stenosis
- ventricular septal defect
- auriculo-ventricular block
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