Biederman A, Walczak F, Nyznyk M, Stepińska J, Jedynak Z, Göttner B, Reszka Z, Sliwiński M, Hoffman M
I kliniki Kardiochirurgii, Warszawie.
Kardiol Pol. 1990 Jan;33(1):40-9.
The case of surgical treatment of a 44-years old female with a double atrio-ventricular accessory pathway and mitral stenosis was described. Fast ventricular rates due to conduction through the accessory pathways during atrial fibrillation in course of mitral stenosis caused severe heart failure, occasionally with deep hypotonia. Combined treatment with prajmaline and propafenone blocked conduction through accessory pathways. The ventricular rate slowed from approx. 200/min to 150/min. Addition of digoxin slowed the ventricular rate down to approx 80-100/min. There were no signs of preexcitation. Treatment with diuretics and vasodilators was continued. The state of patient improved. Echocardiographic and hemodynamic evaluation revealed: mitral stenosis (orifice - 75 mm2) with moderate regurgitation, small aortic and tricuspid regurgitation. The coronary arteries were normal. On the base of the ECG recordings during atrial fibrillation both accessory pathways were localized on lateral and posterior parts of the left free wall. The patient was operated on. Both atrio-ventricular by-pass tracts were dissected using Sealy's method in Cox modification and then mitral valve prosthesis Medtronic-Hall 27 mm was implanted. Prajmaline and propafenone were discontinued and preexcitation did not recovered. The sinus rhythm was restored by electroversion. The patient had no overt heart failure on discharge from the Institute.
描述了一名44岁患有双房室旁道和二尖瓣狭窄的女性的外科治疗病例。二尖瓣狭窄过程中房颤时经旁道传导导致心室率加快，引起严重心力衰竭，偶尔伴有严重低血压。丙胺苯丙酮和普罗帕酮联合治疗阻断了经旁道的传导。心室率从约200次/分钟降至150次/分钟。加用地高辛后心室率降至约80 - 100次/分钟。无预激迹象。继续使用利尿剂和血管扩张剂治疗。患者状况改善。超声心动图和血流动力学评估显示：二尖瓣狭窄（瓣口面积 - 75平方毫米）伴中度反流，轻度主动脉瓣和三尖瓣反流。冠状动脉正常。根据房颤时的心电图记录，两条旁道均位于左游离壁的外侧和后部。对该患者进行了手术。采用Cox改良的Sealy方法解剖两条房室旁路，然后植入Medtronic - Hall 27毫米二尖瓣假体。停用丙胺苯丙酮和普罗帕酮，预激未恢复。通过电复律恢复窦性心律。患者出院时无明显心力衰竭。
