Surgical treatment of Wolf-Parkinson-White syndrome during plastic operations in patients with Ebstein's anomaly.

OBJECTIVE: Ebstein's anomaly is the most common pathology associated with the accessory conduction pathways. METHODS: From January 1990 to August 1999 48 patients underwent surgical repair of Ebstein's anomaly by various plastic techniques. The pathways were identified and characterized at preoperative electrophysiologic mapping in 17 (34.5%) patients. There were seven males and ten females. The patients age ranged 6-35 years (mean 12.7+/-2.1 years). Five patients were in NYHA class II and were in 12 in NYHA class III. The cardiothoracic ratio ranged from 0.59 to 0.69 (mean 0.65+/-0.08). Tachycardia was present in 15 patients with Wolf-Parkinson-White (WPW) syndrome. Atrial septal defect was present in 12 patients (70. 6%). Accessory conduction pathways were in the right posterior septal area in seven patients, in right posterior septal area and free wall in seven patients and in right free wall in three. The pathways were successfully ablated in all patients during cardiopulmonary bypass. RESULTS: There were no deaths, no relapses. Follow-up ranged from 4 months to 7 years (mean 4.7+/-1.1 years). There were no late deaths, but one patient required successful tricuspid valve replacement because of severe tricuspid insufficiency. At follow-up 57.8% of patients were in NYHA class I. CONCLUSIONS: Preoperative electrophysiologic study allows to identify the accessory conduction pathways in patients with Ebstein's anomaly. The combined approach of tricuspid valve repair and surgical ablation of accessory atrioventricular connections has been proved safe and effective. This operative procedure allows to improve functional results in patients with Ebstein's malformation and concomitant accessory conduction pathways.

Surgical treatment of supraventricular tachycardia: experience with 61 patients.

Sixty-one patients underwent operation for supraventricular tachycardia: 52 had tachycardia associated with the atrioventricular accessory pathways; 9 patients had other forms of tachycardia. Accessory pathways were successfully divided in 92.3% of the patients. Classic endocardial approach was used in 30 patients; closed heart ablation of the accessory pathways was performed in 22 patients. There were two reoperations for return of conduction through the accessory pathways. Six patients underwent cryoablation of the His bundle through the right atrial approach. Four patients underwent attempts at curative operations for atrioventricular node reentry tachycardia, atrial flutter, and atrial ectopic tachycardia. Concomitant cardiac surgical procedures were performed in 14 patients. Operative mortality was 1.6%. A satisfactory result, without tachycardia and without medication, was achieved in 93.4% of all patients.