Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2020; 8(22): 5715-5721
Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5715
Completed atrioventricular block induced by atrial septal defect occluder unfolding: A case report
Chuan He, Yang Zhou, Si-Si Tang, Li-Hong Luo, Kun Feng
Chuan He, Yang Zhou, Si-Si Tang, Li-Hong Luo, Kun Feng, Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
Author contributions: He C and Zhou Y performed the operation; Tang SS designed this case report; Luo LH wrote this paper; Feng K was responsible for sorting the data.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kun Feng, MD, Professor, Department of Cardiology, Affiliated Hospital of Chengdu University, No. 82 North Second Section, Erhuan Road, Jinniu District, Chengdu 610081, Sichuan Province, China. fengkundoctor@163.com
Received: July 28, 2020
Peer-review started: July 28, 2020
First decision: August 7, 2020
Revised: September 15, 2020
Accepted: September 22, 2020
Article in press: September 22, 2020
Published online: November 26, 2020
Processing time: 120 Days and 5.6 Hours
Abstract
BACKGROUND

An atrial septal defect is a common condition and accounts for 25% of adult congenital heart diseases. Transcatheter occlusion is a widely used technique for the treatment of secondary aperture-type atrial septal defects (ASDs).

CASE SUMMARY

A 30-year-old female patient was diagnosed with ASD by transthoracic echocardiography (TTE) 1 year ago. The electrocardiogram showed a heart rate of 88 beats per minute, normal sinus rhythm, and no change in the ST-T wave. After admission, TTE showed an atrial septal defect with a left-to-right shunt, aortic root short-axis section with an ASD diameter of 8 mm, a parasternal four-chamber section with an ASD diameter of 9 mm, and subxiphoid biatrial section with a diameter of 13 mm. Percutaneous occlusion was proposed. The intraoperative TTE scan showed that the atrial septal defect was oval in shape, was located near the root of the aorta, and had a maximum diameter of 13 mm. A 10-F sheath was placed in the right femoral vein, and a 0.035° hard guidewire was used to establish the transport track between the left pulmonary vein and the inferior vena cava. A shape-memory alloy atrial septal occluder with a waist diameter of 20 mm was placed successfully and located correctly. TTE showed that the double disk unfolded well and that the clamping of the atrial septum was smooth. Immediately after the disc was revealed, electrocardiograph monitoring showed that the ST interval of the inferior leads was prolonged, the P waves and QRS waves were separated, a junctional escape rhythm maintained the heart rate, and the blood pressure began to decrease. After removing the occluder, the elevation in the ST segment returned to normal immediately, and the sinus rhythm returned to average approximately 10 min later. After consulting the patient’s family, we finally decided to withdraw from the operation.

CONCLUSION

Compression of the small coronary artery, which provides an alternative blood supply to the atrioventricular nodule during the operation, leads to the emergence of a complete atrioventricular block.

Keywords: Completed atrioventricular block; Atrial septal defect occluder; Atrial septal defect; Transthoracic echocardiography; Case report

Core Tip: This report introduces a case of complete atrioventricular block caused by atrial septal defect occluder. During the placement of the occluder, a complete atrioventricular block suddenly appeared. Electrocardiograph monitoring showed that the ST interval in the inferior wall lead was prolonged, P wave and QRS complex were separated, the heart rate was maintained by junctional escape rhythm, and the blood pressure began to decrease.