Mahomed Y, King R D, Zipes D P, Miles W M, Prystowsky E N, Heger J J, Brown J W
Department of Surgery, Indiana University School of Medicine, Indianapolis 46223.
Ann Thorac Surg. 1988 May;45(5):495-504. doi: 10.1016/s0003-4975(10)64521-3.
Kent bundle interruption for ventricular preexcitation has been successfully accomplished utilizing several different surgical techniques. The external closed-heart technique of Guiraudon combining surgical dissection and cryoablation has been used to interrupt 52 accessory pathways in 47 consecutive patients since May, 1985. The 35 male and 12 female patients ranged in age from 10 to 67 years (mean, 30 years). There were 25 left free wall, 13 right free wall, 13 posterior septal, and 1 anterior septal accessory pathways. Preoperative and intraoperative electrophysiological studies were performed in all patients to induce the arrhythmia and localize all accessory pathways. The operation consisted of dissection of the atrioventricular fat pad. Following this, the delta wave and retrograde accessory pathway conduction disappeared, thereby indicating successful pathway ablation. In 4 patients with right-sided accessory pathways, interruption of the pathway required cryoablation. Cryolesions (made with cryoprobe at -60 degrees C for two minutes) were created in the region of the accessory pathway insertion. All accessory pathways were successfully ablated without any deaths or heart block. Concomitant surgical procedures were performed in 4 patients. Two patients required a second operation the next day for an accessory pathway not found at the initial operation. Three patients had postpericardiotomy syndrome, and 4 had recurrent atrial fibrillation requiring therapy. The remaining patients have had no arrhythmia recurrence and have remained drug free after a follow-up of 1 month to 22 months (mean, 12.5 months). We conclude that the closed-heart technique of accessory pathway ablation is safe and reproducible, obviates the necessity for aortic cross-clamping and cardioplegic arrest, and allows instantaneous monitoring of conduction over the pathway.
自1985年5月以来，已运用多种不同的外科技术成功完成了用于治疗心室预激的肯特束阻断术。吉劳东的体外心脏闭合技术结合了手术解剖和冷冻消融，自1985年5月起已用于连续47例患者，阻断了52条附加通路。35例男性和12例女性患者年龄在10至67岁之间（平均30岁）。有25条左游离壁附加通路、13条右游离壁附加通路、13条后间隔附加通路和1条前间隔附加通路。所有患者均进行了术前和术中电生理研究，以诱发心律失常并定位所有附加通路。手术包括解剖房室脂肪垫。在此之后，δ波和逆行附加通路传导消失，从而表明通路消融成功。在4例右侧附加通路患者中，通路阻断需要冷冻消融。在附加通路插入区域用冷冻探头在-60℃下制作冷冻损伤两分钟。所有附加通路均成功消融，无死亡或心脏传导阻滞发生。4例患者同时进行了其他外科手术。2例患者在第二天因初次手术时未发现的附加通路而需要再次手术。3例患者发生了心包切开术后综合征，4例患者有复发性房颤需要治疗。其余患者在随访1个月至22个月（平均12.5个月）后无心律失常复发，且未再用药。我们得出结论，附加通路消融的心脏闭合技术是安全且可重复的，无需主动脉交叉钳夹和心脏停搏，并允许对通路传导进行即时监测。
