预激综合征的外科治疗

Surgical treatment of the Wolff-Parkinson-White syndrome

目的 评价外科治疗预激综合征 (WPW )的效果。方法 1992年 7月至 2 0 0 1年 9月手术治疗WPW 2 6 (男 14、女 12 )例 ,其中 2 2例合并其他器质性心脏病。WPW为B型 18例、A型 8例 ,2 6例共有 2 8条附加旁道 (2例双旁道 ) ,其中位于右心室游离壁 13条、后间隔 7条、左心室游离壁 5条和前间隔 3条。术前曾行射频消融失败 12例。在体外循环下施行手术切割附加旁道或加局部冷冻 ,同期处理合并病变。结果 附加旁路即刻切割成功 2 8条 (10 0 % )。术后早期复发 2例 (8 3% ) ,予射频消融治愈 ;2例残留Delta预激波 ,但电生理检查不能诱发室上性心动过速 ;早期死亡 1例(3 8% )。 2 4例 (96 0 % )术后长期随访 1个月～ 9年 ,平均 (4 13± 2 6 4 )年 ,无复发和晚期死亡。结论 严格选择手术适应证 ,术前或术中电生理检查明确附加旁路部位和数量 ,熟悉附加旁路的解剖特点和掌握手术切割技巧是取得WPW外科治疗良好效果的关键。

Objective To evaluate the efficacy of surgical ablation for the treatment of Wolff-Parkinson-White (WPW) syndrome. Methods Between July 1992 and September 2001, 26 consecutive patients with WPW syndrome underwent surgical ablation of the accessory pathway (AP). There were 14 male and 12 female patients with age ranging from 3 to 61 (mean 29.12±13.46)years old. Twenty-two patients had additional congenital or acquired heart disease. A total of 28 AP ( 24 single and 2 double) in 26 patients were identified and located by electrocardiography and electrophysiological mapping before or during operation, including 13 in right free wall, 7 in posterior septal area, 5 in left free wall and 3 in anterior septal area. All AP were surgically dissected during cardiopulmonary with heart beating or under cardioplegic heart arrest. A cryosurgery was also used in 7 patients. Simultaneously, surgical operations of concomitant congenital or acquired disease were performed in 22 patients. Results All AP were ablated successfully (100%) without severe or permanent atrioventricular heart block. One early death (3.8%) occurred. Two patient (8.3%) recurred tachyarrhythmia two days and one month after operation, respectively, which was treated successfully by radiofrequency ablation. Twenty-four patients (96.0%) were followed up from 1 month to nine years with a mean of 4.13±2.64 years. Two patient re-appeared delta wave before discharge and maintained during follow-up period but without inducible tachyarrhythmia by electrophysiological examination. There were no late deaths. Conclusion The key points for achieving good surgical results of WPW syndrome are choosing suitable operative indication, localizing AP accurately by electrophysiologic examination, being familiar with the anatomic distribution of AP and mastering surgical ablation techniques.