# A case report of delayed persistent third-degree atrioventricular block 7 years after eccentric umbrella occlusion of a perimembranous ventricular septal defect in infancy

## TL;DR

A child who had a heart defect closed with an umbrella device in infancy later developed a serious heart rhythm issue seven years later.

## Contribution

This case highlights the long-term risk of delayed complete heart block following early childhood use of an eccentric umbrella for heart defect closure.

## Key findings

- A child developed third-degree atrioventricular block seven years after an eccentric umbrella occlusion.
- The conduction abnormality persisted despite occluder removal and steroid therapy.
- Long-term ECG monitoring is recommended for high-risk patients with occluders near the conduction system.

## Abstract

This article reports an 8-year-old female patient who underwent trans-thoracic small-incision interventional Pm-VSD occlusion with an eccentric umbrella (defect diameter 10 mm, occluder waist diameter 12 mm) at 4 months of age (July 2017). Seven years after the operation (October 2024), she gradually developed third-degree atrioventricular block. Despite the removal of the occluder and ventricular septal defect repair combined with steroid pulse therapy, the conduction abnormality persisted. This case, with a 7 - year disease course evolution, provides in - depth insights into the development process of delayed complete atrioventricular block (CAVB) following eccentric umbrella occlusion in infancy and early childhood, particularly for high - risk patients with occlusion adjacent to the conduction system. It also suggests the significance of electrocardiogram monitoring for over 5 years post - operation in such high - risk patients.