Late complete atrioventricular block after closure of an atrial septal defect with a gore septal occluder (GSO™)

Abstract

Temporary intermittent complete heart block (CHB) occurred the day after interventional closure of an ASD with a 30 mm Gore Septal Occluder (GSO™) in a 2 years and 11‐month‐old female. CHB disappeared without further treatment and stable sinus rhythm recovered within 3 days. Only short episodes of 2nd degree AV‐block (Wenckebach periodicity) at rare intervals were documented in Holter‐monitors the following 2 months. Eleven months after device implantation the patient suffered from long lasting episodes of CHB. Surgical removal of the device resulted in incomplete recovery of AV‐conduction. Histopathological work‐up of the explanted GSO showed complete endothelialization of the device and regular scar formation. One year after surgery, the child had sinus rhythm during daytime but needed VVI‐pacing while sleeping. Young age, inferior localization of the defect, and use of a large device have been individual risk factors for CHB in this patient. Clinical course and histologic findings indicate that mechanical compression was the only cause for CHB. The cumulative number of reports of CHB after use of different ASD‐devices supports the recommendation to postpone the intervention in asymptomatic patients to preschool‐age. Early removal of a pushing device may increase the chance of complete recovery from CHB. © 2015 Wiley Periodicals, Inc.

Case report: Atrioventricular block after transcatheter atrial septal closure using the Figulla® Flex II ASD occluder

“…It was speculated that the compression of Koch's triangle by the RA disk caused complete heart block. Dittrich et al also demonstrated a case of irreversible heart block 11 months after ASD closure using a Gore Septal Occluder that was adherent to the triangle . Our case demonstrated actual hematoma in the area 24 hr after deployment.…”

“…Temporary AV block during catheter intervention does not always preclude the device closure of the ASD; however, flow acceleration between the RA disk and the coronary sinus ostium as well as continuous contact of the RA disk on the commissure of the non‐coronary sinus and right coronary sinus of Valsalva, where the AV node is located, in the presence of intermittent AV block as seen in our case (Figure A,B) is suggestive of significant interference of the AV conduction system. In such cases, the mechanical compression should be removed by retrieving or downsizing of the disk, as the AV node dysfunction can be irreversible …”

Multicenter midterm follow‐up results using the gore septal occluder for atrial septal defect closure in pediatric patients

“…Transcatheter device closure of secundum‐type atrial septal defects (ASD II) has become widely accepted as an alternative to surgical repair in patients with suitable anatomical conditions . However, cardiac erosion following implantation of closure devices remains problematic , as does the risk of device‐related complete atrioventricular block , device embolization , and mechanical device failure . Patch‐like Gore devices (W.L.…”

Early Progressive Atrioventricular Block After Amplatzer Septal Occluder Closure of a Large Atrial Septal Defect

“…Some thought has been given as to whether the ASO device design makes it susceptible to causing AV block but the Gore Septal Occluder (GSO™)has reported as well [10]. Some studies have proposed an elevated ratio of ASO/atrial septal length and/or deficient aortic or posterior rim may be predictive of higher incidence of AV block [7,11]. Also, the decision to treat medically or remove the device is not well defined [6,10,12,13].…”