Open Access

ARTICLE

Long-Term Follow-Up Study on Electrophysiology Guidance for Transcatheter Closure of Perimembranous Ventricular Septal Defect in Adults

Wenrui Li¹, Nanshan Xie¹, Xianzhang Zhan¹, Ziyang Yang², Hezhi Li¹, Caojin Zhang^1,*
1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510000, China
2 Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510000, China
* Corresponding Author: Caojin Zhang. Email:

Congenital Heart Disease https://doi.org/10.32604/chd.2024.053604

Received 06 May 2024; Accepted 21 November 2024; Published online 17 December 2024

Abstract

Objectives: To explore the feasibility and efficacy of electrophysiology guidance for transcatheter closure of perimembranous ventricular septal defect (PmVSD) in adults. Methods: 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. Results: 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. Conclusions: 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.

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Keywords

Ventricular septal defect; transcatheter closure; His-Purkinje system; 3D electro-anatomic mapping

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