Guiraudon G M, Guiraudon C M, Klein G J, Sharma A D, Yee R
Department of Surgery, University of Western Ontario, University Hospital, London, Canada.
Am J Cardiol. 1988 Oct 1;62(10 Pt 1):733-5. doi: 10.1016/0002-9149(88)91212-x.
Of 65 patients with posterior septal accessory pathways, 6 were found intraoperatively to have a previously unrecognized pathologic entity: a coronary sinus (CS) diverticulum in the posterior septal region. The CS diverticulum is a venous pouch within the left ventricular wall, with a neck opening into the CS. The pouch, 2 to 5 cm in diameter, has a deep wall corresponding to the left ventricular wall, with venous channel openings and a thin superficial wall made of myocardium. The CS diverticulum neck is 5 to 10-mm wide, opens into the CS and is proximal to the midcardiac vein. Using an epicardial approach during normothermic bypass, the neck of the CS diverticulum was identified, separated from the left ventricle and then closed. Accessory pathway conduction disappeared only after separation of the CS diverticulum neck. The accessory pathway is intimately related to the diverticulum. The latter is a bridge between the left ventricle and the right or left atrium. The accessory pathways associated with CS diverticula had short anterograde refractory periods and were associated with potentially malignant arrhythmias. An epicardial operative approach with division of the neck of the diverticulum is recommended when surgery is indicated.
在65例后间隔旁路患者中，术中发现6例存在一种先前未被认识的病理实体：后间隔区域的冠状静脉窦（CS）憩室。CS憩室是左心室壁内的一个静脉囊袋，其颈部开口于CS。该囊袋直径为2至5厘米，有一层与左心室壁相对应的厚壁，有静脉通道开口，还有一层由心肌构成的薄的浅表壁。CS憩室颈部宽5至10毫米，开口于CS，且靠近心中静脉。在常温体外循环期间采用心外膜入路，识别出CS憩室的颈部，将其与左心室分离，然后进行封闭。仅在CS憩室颈部分离后，旁路传导才消失。旁路与憩室密切相关。后者是左心室与右心房或左心房之间的一座桥梁。与CS憩室相关的旁路具有短的前向不应期，并与潜在的恶性心律失常相关。当需要手术时，建议采用心外膜手术入路并切断憩室颈部。
