Dick M, Norwood W I, Chipman C, Castaneda A R
Circulation. 1979 Jan;59(1):150-60. doi: 10.1161/01.cir.59.1.150.
Intraoperative mapping of the specialized atrioventricular conduction system was performed in 47 patients during cardiac surgery. Specialized conduction tissue electrograms were identified in 37, and atrioventricular conduction preserved in 92%. Specialized conduction tissue was identified in 27 patients with atrioventricular canal defect: complete heart block was avoided in 25. Conduction tissue was located in six of 12 patients with complex transpositions; atrioventricular conduction was preserved in all six. Other lesions in which the technique was useful were Ebstein's anomaly and single atrium. Limitations to the technique are 1) deep hypothermia and circulatory arrest; 2) interruption in atrioventricular conduction during mapping; 3) inadequate exposure and access to probable sites of conduction tissue; 4) variation of size and spatial relations of individual malformations; and 5) limited time for identification of unusually located conduction tissue. Indications for use of this technique include patients with both forms of atrioventricular canal, complex transpositions, atrioventricular discordance, single ventricle and single atrium.
在47例心脏手术患者中进行了术中特殊房室传导系统标测。37例患者识别出特殊传导组织电图，92%的患者房室传导得以保留。在27例房室管缺损患者中识别出特殊传导组织：25例避免了完全性心脏传导阻滞。12例复杂型大动脉转位患者中有6例发现传导组织；6例患者的房室传导均得以保留。该技术还适用于其他病变，如埃布斯坦畸形和单心房。该技术的局限性包括：1）深度低温和循环停止；2）标测过程中房室传导中断；3）对传导组织可能部位的暴露和进入不足；4）个体畸形的大小和空间关系存在差异；5）识别位置异常的传导组织的时间有限。该技术的应用指征包括两种类型的房室管、复杂型大动脉转位、房室不一致、单心室和单心房患者。
