预激综合征异常房室传导束切断的外科治疗

SURGICAL TREATMENT OF PREEXCITATION SYNDROME BY INTERRUPTION ACCESSORY ATRIOVENTRICULAR CONDUCTION PATHWAY

自1986年3月到1991年8月行异常房室传导束切断治疗预激综合征53例,其中左室22例,右室17例,左室加右室7例,后间隔6例和前间隔1例;同时施行先天性心脏畸形和心脏瓣膜病等手术17例,手术病死率为1.9％。52例经6个月到6年随诊,证实异常房室传导束切断成功率为94.3％。我们主张采取较积极的态度进行预激综合征的外科治疗,经电生理检查和心外膜标测作异常房室传导束的准确定位,施行较广较深范围的切割,就能提高其外科治疗效果。

From March 1986 through August 1991. 53 cases of preexcitation syndrome were treated by interruption the accessory atrioventricular conduction pathway in our institute. Of the 53 patients, accessory pathway was localized in left ventricle in 22 cases, right ventricle in 17 cases, right and left ventricle in 7 cases, posterior spetum in 6 cases, anterior septum in 1 case, and association cardiac anomalies or cardiac valvular lesions were repaired in 17 cases. Operative mortality rate was 1.9%. Follow-up for 6 months to 6 years in 52 patients, in 94.3% of them complete section of the accessory atrioventricular conduction pathway was confirmed. We proposed that preexcitation syndrome should actively be treated with surgical means, and the results of surgical treatment would be improved by precise localization of the accessory pathway, which could be identified by electrophysiological examination and epicardial mapping, and a deeper and wider ablation should be done in the accessory pathway region.