Guiraudon G M, Klein G J, Gulamhusein S, Jones D L, Yee R, Perkins D G, Jarvis E
Ann Thorac Surg. 1984 Jan;37(1):67-71. doi: 10.1016/s0003-4975(10)60713-8.
The conventional operation for ablation of accessory pathways in Wolff-Parkinson-White (WPW) syndrome requires an endocardial approach and necessitates cardiopulmonary bypass and hypothermic cardiac arrest. Cryosurgical ablation of these pathways from the epicardial surface has been described but limited to superficial accessory pathways. We report a new closed-heart technique combining dissection of the atrioventricular (AV) pad and cryosurgery. Six patients with WPW syndrome underwent operation for ablation of accessory pathways associated with disabling tachyarrhythmia refractory to medical management. All pathways were located in the left lateral AV sulcus as determined by preoperative and intraoperative electrophysiological assessment. The heart was exposed through a median sternotomy. The AV fat pad and its vascular contents were dissected away from the atrium at the site of the pathway. A small segment of the ventricle adjacent to the sulcus was exposed. The fat pad was retracted to avoid cryoinjury to the coronary vessels. A cryoprobe, 1.5 cm in diameter, was applied to the exposed AV junction (-60 degrees C for 2 minutes) to create transmural fibrosis. After ablation of the pathway was verified, the chest was closed. All 6 patients have remained free from preexcitation during short-term follow-up. This simplified technique is applicable to patients with free wall accessory pathways. This group constitutes the majority of symptomatic patients with WPW syndrome at our institution.
用于消融预激综合征（WPW）中旁路的传统手术需要经心内膜途径，且必须进行体外循环和低温心脏停搏。已经描述了从心外膜表面冷冻消融这些旁路，但仅限于浅表旁路。我们报告一种新的闭式心脏技术，该技术结合了房室（AV）垫的解剖和冷冻手术。6例WPW综合征患者接受了手术，以消融与药物治疗无效的致残性快速心律失常相关的旁路。术前和术中电生理评估确定所有旁路均位于左侧房室沟。通过正中胸骨切开术暴露心脏。在旁路部位将房室脂肪垫及其血管内容物从心房分离。暴露沟附近一小段心室。将脂肪垫牵开以避免冷冻损伤冠状动脉。将直径1.5 cm的冷冻探头置于暴露的房室交界处（-60℃，持续2分钟）以形成透壁纤维化。在确认旁路消融后，关闭胸腔。所有6例患者在短期随访期间均未再出现预激。这种简化技术适用于有游离壁旁路的患者。在我们机构，这组患者构成了有症状WPW综合征患者的大多数。
