TY  - EJOU
AU  - Li, Wenrui 
AU  - Xie, Nanshan 
AU  - Zhan, Xianzhang 
AU  - Yang, Ziyang 
AU  - Li, Hezhi 
AU  - Zhang, Caojin 

TI  - Long-Term Follow-Up Study on Electrophysiology Guidance for Transcatheter Closure of Perimembranous Ventricular Septal Defect in Adults
T2  - Structural and Congenital Heart Disease

PY  - 2024
VL  - 19
IS  - 5
SN  - 3071-1738

AB  -  <b>Objectives:</b> To explore the feasibility and efficacy of electrophysiology guidance for transcatheter closure of perimembranous ventricular septal defect (PmVSD) in adults.  <b>Methods:</b> Adult patients with PmVSD who underwent transcatheter in Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute from February 2016 to January 2018 were selected. The distribution of the His-Purkinje system (HPS) close to the margins of PmVSD in the left ventricle was identified using three-dimensional (3D) electro-anatomic mapping and near-field HPS was further confirmed by different pacing protocols. The follow-up protocol included electrocardiogram (ECG)and transthoracic echocardiography at 6, 24, 72 h, 1, 3, 6 months and 1, 2, 3, 5 years after the procedure.  <b>Results:</b> Of the 21 patients in the study, with an average age of 28.1 years, 61.9% were female and 38.1% were male. Eighteen patients (85.7%) successfully underwent transcatheter intervention. The minimum distance between the margins of the PmVSD and near-field HPS ranged from 2.5 ± 0.7 (1.3~3.9) mm. An average follow-up period was 4.1 ± 1.3 (0.25~5) years, median of which was 5 years. 1, 3, 5-year follow-up rate was 95.2%, 90.4% and 52.4%, respectively. At the end of the follow-up, ECG abnormalities were observed in 5 cases (23.8%), including left anterior hemiblock (LAH) in 3 cases (14.3%), incomplete right bundle branch block and LAH in 1 case (4.8%), premature atrial contraction in 1 case (4.8%). Mild tricuspid regurgitation (TR) and mild TR with mild mitral regurgitation with mild aortic regurgitation was observed in 1 case (4.8%), as well as left ventricular diastolic dysfunction. <b>Conclusions:</b> The study indicates that the results have guiding significance for transcatheter closure of PmVSD guided by 3D electro-anatomic mapping technique. However, this method requires a larger amount of clinical research data to support.
KW  - Ventricular septal defect; transcatheter closure; His-Purkinje system; 3D electro-anatomic mapping

DO  - 10.32604/chd.2024.053604