Surgical treatment of the Wolff-Parkinson-White syndrome in infants and children.

Eleven pediatric Wolff-Parkinson-White (WPW) syndrome patients underwent surgery. Four had left, 5 right cardiac type and 2 had right septal type WPW syndrome. Two patients had 2 accessory conduction pathways (ACP). Ebstein's anomaly and secundum type atrial septal defect were the association congenital cardiac diseases in one patient each. Indications for surgery included repeated and/or long-lasting paroxysmal supraventricular tachycardia (PSVT), ineffective drug therapy, cardiac failure due to frequent tachycardia, short effective refractory period of the ACP, and simultaneous surgery for associated congenital cardiac diseases. Pre- and intra-operative examinations, including ECG, VCG, UCG, body surface mapping, intracavitary recording by catheter electrodes, computerized epicardial mapping, and endocardial mapping, were performed for the precise localization of the ACP. The surgical method was basically the same as is used for adults. Anterior median stermotomy was used primarily in right cardiac and right septal type and left anterior thoracotomy was used in 3 of 4 cases of the left cardiac type. Eight of 11 cases, two of which had 3 ACPs, were completely cured and in 3 there was evidence of postoperative pre-excitation. However, the PSVT attacks disappeared almost completely and drug therapy is not required at present.