Selle J G, Sealy W C, Gallagher J J, Fedor J M, Svenson R H, Zimmern S H
Ann Thorac Surg. 1987 Jun;43(6):579-84. doi: 10.1016/s0003-4975(10)60225-1.
Surgical techniques for the approach to and division of atrioventricular accessory pathways have been designed and perfected during the past 18 years. The standard method of exposure of a single left free wall accessory pathway is by a left atriotomy. All other single accessory pathways are exposed through a right atriotomy. Up to twenty percent of patients with Wolff-Parkinson-White (WPW) syndrome harbor multiple atrioventricular accessory pathways. In this subgroup, classic operative techniques, especially the methods of approach, must be combined or modified depending on the specific locations of the accessory pathways encountered. Eighteen of 90 patients operated on for WPW syndrome at Charlotte Memorial Hospital from August, 1983, through September, 1986, had multiple accessory pathways. Thirty-eight of thirty-nine pathways were successfully divided. One posterior septal accessory pathway reappeared 2 months postoperatively and was catheter ablated. The most frequent combination of atrioventricular accessory pathways included a right free wall and a posterior septal accessory pathway (10 patients). This combination is approached by a right atriotomy. The posterior septal space dissection is extended onto the right free wall area. Technically the most difficult combination includes a left free wall and a posterior septal accessory pathway (3 patients in the present series). Our preferred approach is begun with a right atriotomy for the posterior septal space dissection, followed by an atrial septotomy to expose the left free wall area. There are other methods, however, that may be advantageous depending on the exact locations of the accessory pathways encountered.
在过去18年里，用于接近和切断房室旁道的手术技术已被设计并完善。暴露单个左游离壁旁道的标准方法是通过左心房切开术。所有其他单个旁道则通过右心房切开术暴露。高达20%的预激综合征（WPW）患者存在多条房室旁道。在这个亚组中，经典的手术技术，尤其是入路方法，必须根据所遇到的旁道的具体位置进行组合或修改。1983年8月至1986年9月在夏洛特纪念医院接受WPW综合征手术的90例患者中，有18例存在多条旁道。39条旁道中有38条成功切断。一条后间隔旁道在术后2个月复发，通过导管消融术处理。最常见的房室旁道组合包括右游离壁和后间隔旁道（10例患者）。这种组合通过右心房切开术处理。后间隔间隙的分离延伸至右游离壁区域。技术上最困难的组合包括左游离壁和后间隔旁道（本系列中有3例患者）。我们首选的方法是先通过右心房切开术进行后间隔间隙的分离，然后进行房间隔切开术以暴露左游离壁区域。然而，根据所遇到的旁道的确切位置，还有其他可能有利的方法。
