Journal of JCIC

The Gore® Cardioform ASD Occluder (GCA) is a flexible device with a low incidence of erosion. However, atrioventricular (AV) block has occasionally been reported when using the GCA. Here, we report the case of a 13-year-old girl with atrial septal defect (ASD). An ASD defect measuring 18 mm, a deficient aortic rim, and poor superior rim were observed. The atrial septal length was 44 mm. We selected a 44 mm GCA because of the deficient aortic rim and poor superior rim. After the device was deployed, a first-degree AV block occurred, which temporarily progressed to a Wenckebach-type second-degree AV block. However, the conduction disturbance improved within 10 days after initiation of oral steroid therapy. In this case, using a large-sized device relative to the septal length provided wide coverage of the atrial septum, and mechanical compression was thought to be the cause of the AV block. On the other hand, improvement in the AV block after the initiation of steroid therapy suggests that reversible factors, such as inflammatory edema, may also have been involved. Although an AV block may occur with the GCA depending on the anatomical conditions and device selection, the decision to retrieve the device should be made with caution, and conservative management, including steroid therapy, may be considered.