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

作　　者：Wenrui Li Nanshan Xie Xianzhang Zhan Ziyang Yang Hezhi Li Caojin Zhang 

机构地区：[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

出　　处：《Congenital Heart Disease》2024年第5期445-455,共11页先天性心脏病（英文）

摘　　要：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.

关 键 词：Ventricular septal defect transcatheter closure His-Purkinje system 3D electro-anatomic mapping 

分 类 号：R541[医药卫生—心血管疾病]