A n 11-month-old girl presented with tachypnea and a grade 3/6 systolic heart murmur on her physical examination when receiving a scheduled vaccination. Chest radiography showed cardiomegaly and increased lung markings. Transthoracic color Doppler echocardiography showed a type-2 atrial septal defect and an abnormal turbulent flow from the lateral wall of the left ventricle (LV), but both coronary arteries appeared normal. Cardiac catheterization was performed that revealed 2 oxygen-saturation step-ups, 1 at the right ventricle (from 62% to 85%) and the other at the pulmonary artery (PA) (from 85% to 87%), with a total Qp/Qs of 3.5. An angiogram of the LV showed 2 fistulas originated from the lateral wall of the LV and then joined together to drain into the posterior-lateral side of the PA (A, Online Video 1). An aortogram showed a normal pattern of coronary arteries. A cardiovascular computed tomography scan also confirmed abnormal communication between the LV and PA (B). The white arrows in B indicate the abnormal LV-to-PA fistula.
Acquired complete atrioventricular block that is caused by infectious myocarditis is usually transient and has a favourable outcome. We report the case of a 15-year-old girl who had complete infra-Hisian atrioventricular block due to adeno viral myocarditis and received a permanent pacemaker at the age of 10 months. The pacemaker lost its function at the age of 7 years. However, she experienced a late recurrence of complete atrioventricular block 10 years later. Complete atrioventricular block is rarely recovered if it persisted for 2 weeks. Even in the patients with late recovery, long-term follow-up and pacemaker therapy are still needed.
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