case_images: PMC6985450_01
case_images: Echocardiography and DSA imaging. (a) Two-dimensional echocardiography showing pmVSD in the apical five-chambered view. (b) Color Doppler echocardiography showing pmVSD (left to right shunt) in the short-axis view. (c) DSA image showing left to right shunt through the pmVSD in the left anterior oblique position. (d) DSA image showing no residual shunt post transcatheter closure with MODO.
case_images: fped-07-00545-g0001.jpg
case_images: PMC6985450_01_fped-07-00545-g0001.jpg
case_images: F1
case_images: Transthoracic echocardiography (TTE) revealed the diameter of the pmVSD to be 4 mm (Figure 1) and the left ventricle diastolic diameter to be 3.1 cm (z-score of 0.04). The 6-mm symmetric ventricular septal device was a modified double-disc VSD occluder (MDVO) (Shanghai Shape Memory Alloy) (Figure 1).
case_images: Electrocardiogram. (a) Normal sinus rhythm pre occluder closure. (b) Normal sinus rhythm and CRBBB immediately post closure. (c) CAVB 2.5 years post closure. (d) Normal sinus rhythm recovery and CRBBB post surgical removal of occluder 3 months later.
case_images: fped-07-00545-g0002.jpg
case_images: PMC6985450_01_fped-07-00545-g0002.jpg
case_images: F2
case_images: A 12-lead electrocardiogram (EKG) and 24-h electrocardiographic Holter showed normal sinus rhythm (Figure 2). EKG showed normal sinus rhythm and complete right bundle branch block (CRBBB) immediately post pmVSD closure (Figure 2). TTE revealed no displacement of the occlude, and EKG showed normal sinus rhythm and CRBBB post closure (Figure 2). Two and half years post pmVSD closure, astonishingly, a routine follow-up examination showed a high degree atrioventricular block, and CAVB (Figure 2); the patient's parents refused to implant a permanent pacemaker. One week later, sinus rhythm recovered, and CRBBB still existed (Figure 2).