The results of surgery for tachyarrhythmias in children.

Tachycardia in children is generally considered harmful and frequently is transformed into so-called arrhythmogenic cardiomyopathy. The goal of this report was the investigation of the result of surgical treatment and how it was dependent on the type of tachycardia, the presence of combined, or concomitant heart pathology. We have operated on 146 patients at an age of 8 months to 16 years (mean 9.6 +/- 2.7 yrs) from 1982 until April 1, 1990. Surface mapping was performed in patients with WPW syndrome. All patients underwent electrophysiological study. The duration of the disease was 8.4 +/- 1.9 years. 89% of patients suffered from syncopal episodes. The heart rate during tachycardia exceeded 200 beats/min in 95% of children. In 98% of patients palpitation lasted more than 3 hours. Seven types of tachycardia were seen in operated children. All patients were divided into three groups depending on the absence or presence of CHD or several types of arrhythmia. Sixty-seven patients (45.8%) with so-called noncomplicated tachycardias (without additional heart disease) were included in group I. Forty-seven patients (32.2%) with tachycardia and CHD were in group II and 52 patients (21.9%) with multiple tachycardias that had life-threatening prognosis were in group III. The total efficacy of surgical treatment in group I was 97%. The worst results were in group II patients. The total positive results in this group was 81%. In group III patients with life-threatening arrhythmias, total efficacy was 93.8%.

[Evaluation of the results of epicardial electric pulse destruction of the bundle of Kent: immediate and late results]. / Otsenka rezul'tatov operatsii épikardial'noi élektroimpul'snoi destruktsii puchka Kenta: blizhaishie i otdalennye rezul'taty.

The authors assessed the outcomes of an epicardial electrical pulse destructive operation on Kent's bundle in 170 patients with the Wolff-Parkinson-White syndrome. The operation consisted in generating an electrical stimuli train of a power of 50-250 J along the fatty tenial margin of the atrioventricular sulcus, which damaged or isolated Kent's bundle. By refining the indications for application of the method, the authors succeeded in achieving 98% efficacy in abolishing the Kent bundle conduction in the absence of deaths in the latter group of patients. The technique was found to be indicated in lateral bundle localizations, except right anterolateral localizations when atrioventricular conduction disturbances may be present. Myocardial changes occurring after destruction caused no hemodynamic abnormalities and were not associated with coronary artery lesions. Increasing the force of intact myocardial contraction fully compensated a slight segmental ejection fraction deficiency at the site of destruction.

[Surgical treatment of tachycardia in children]. / Khirurgicheskoe lechenie takhikardii u detei.

Based on the outcomes of surgical treatment in 127 children suffering from tachycardias, three clinical groups were identified: Group 1: an uncomplicated course; Group 2: tachycardias concurrent with congenital heart disease; Group 3: life-threatening tachyarrhythmias. The results of surgical treatment were the following by the groups: Group 1 showed its efficacy in 96.5% and a tachycardial relapse in 3.5%, Group 2 displayed it in 81.0%, deaths in 19.0%, Group 3 exhibited it in 93%, deaths in 7%. In the surgical treatment of the Wolff-Parkinson-White syndrome, the method of choice is epicardial fulguration of the accessory atrioventricular pathway (100% versus 89.4% for the W. Sealy procedure).

Anatomical variants of sinoatrial and atrioventricular node arteries.

The authors investigated on 70 hearts taken from deceased subjects of either sex, aged 19 to 75 years, anatomical variants of sinoatrial (SAN) and atrioventricular node (AVN) arteries. As regards the branching of the SAN artery from the right and left coronary artery (RCA, LCA), they found altogether 14 variants of connection with the anterior atrial sulcus and the orifice of the superior vena cava. As regards the branching of the AVN from the RCA and the LCA, they identified altogether 6 variants of connection with the venous sinus orifice and the base of the interventricular septum. Problems of surgical interventions on SAN and AVN arteries and mechanisms of possible traumatization in the course of these operations are discussed. Surgical lesions can be prevented by thorough analysis of coronarograms and by taking into account anatomical variants of SAN and AVN arteries.