Nakano H, Ida T, Harada A, Horiba K, Sakakibara T, Kawase M, Tatsuno K, Obunai Y, Murata M
Kyobu Geka. 1989 May;42(5):358-62.
The patient with the anterior-paraseptal type WPW syndrome was operated upon with closed heart technique (so-called epicardial approach) of cryosurgery. Following intraoperative electrophysiologic studies, with ultrasonic aspirator, the epiannular fat-pad of the anterior right atrium was completely dissected to the epicardial side of the tricuspid annulus. Then the anterior paraseptal accessory pathway on the tricuspid annulus was ablated by cryosurgery (-65 degrees C, 3 min, total 9 trials). With this method, cardiotomy and establishment of cardiopulmonary bypass were not necessary to divide the accessory pathway, and significant hemodynamic instability was not caused. But in the case of accessory pathway near interatrial septum (for example, anterior paraseptal or posteroseptal) WPW syndrome, although cryoprobe was applied just adjacent to the AV node, careful ECG monitoring throughout cryosurgery obviated the injury to the AV node.
采用闭合式心脏技术（所谓的心外膜途径）的冷冻手术对一名前间隔旁道型预激综合征患者进行了手术。术中进行电生理研究后，使用超声吸引器将右房前心外膜脂肪垫完全剥离至三尖瓣环的心外膜侧。然后通过冷冻手术（-65℃，3分钟，共9次尝试）消融三尖瓣环上的前间隔旁道。采用这种方法，无需进行心脏切开和建立体外循环来分离旁道，也不会引起明显的血流动力学不稳定。但对于靠近房间隔的旁道（例如前间隔或后间隔）预激综合征患者，尽管冷冻探头紧邻房室结应用，但在整个冷冻手术过程中仔细监测心电图可避免对房室结造成损伤。
