Surgical treatment of patients with Wolff-Parkinson-White syndrome and associated acquired valvular heart disease.

Between November 1973 and March 1993, 454 patients underwent surgical division of an accessory pathway. The surgical and electrophysiologic data for 15 of these patients who underwent concomitant operation for acquired valvular heart disease were examined. This subgroup consisted of 10 male and 5 female patients whose ages ranged from 11 to 62 years (mean 51.6 +/- 9.7 years). The primary surgical indication was congestive heart failure in all cases; a concomitant history of cardiopulmonary resuscitation was present in two cases. Nine of these patients had mitral valve disease, three had aortic valve disease, two had combined aortic and mitral valve disease, and one had tricuspid valve disease. The surgical technique used for the treatment of Wolff-Parkinson-White syndrome included (1) an endocardial approach with the use of cardioplegic arrest, (2) a sharp dissection of the involved valve anulus, and (3) cryoablation. Concomitant surgical treatments of valvular heart disease included open mitral commissurotomy in five cases, mitral valve replacement in four cases, aortic valve replacement in three cases, aortic valve replacement with mitral valve commissurotomy in two cases, and tricuspid valvuloplasty (De Vega technique) in one case. Other concomitant surgical procedures included tricuspid annuloplasty with atrialized right ventricle and replacement of the ascending aorta in one case and left ventricular myectomy for hypertrophic obstructive cardiomyopathy in one case. No early deaths occurred. A successful disappearance of the delta wave and episodes of recurrent tachycardia were achieved in all 15 patients. Long-term surgical follow-up, averaging 86.2 +/- 54.8 months also demonstrated no late instances or recurrence of either a delta wave or tachycardia.