Surgical Ablation of Wolff – Papkinson - White Syndrome in Children and Young Adults

自1988 年至1991 年問，共有9位WPW症候群病人，年齡從10歲至23歲（中位數為13歲），接受外科切除手術，包括6位明示型及3位隱藏型，手術前接受一般心電圖及包括導管定位術之心臟電生理學檢查，再經手術中心外膜及心內膜定位術來確定其補助路徑（AP ) 之位置。結果顯示；其補助路徑位置分別在房室溝之：左外側4人、右外側3人、右後中隔l人及右前中隔1 人。在6位顯示型病人，利用心電圖上Delta波之極性分析均與導管定位術結果相吻合。手術均採用廣泛心內膜剝離方式，除了l人有暫性術後心包膜切除症候群外，其他病人都沒有手術併發症或死亡；在2年到4年之追綜，亦均不需要繼續服用藥物及無心搏過速之發生。針對這些年紀較輕之病人，我們結論（1）補助路徑及不整脤機轉可由Delta波之極性分析及導管定位術來準確地預測。（2）外科療法是相當安全而有效。（3）如果導管灼燒法不能成功，或是同時伴有需要開刀的心臟病兒，則可採行外科切除法。

關鍵字

無資料

並列摘要

From 1988 to 1991, nine patients with structural normal heart, aged 10 to 23 (median 13 years), Wolff-Parkinson-White Syndrome patients were operated at National Taiwan University Hospital. The diagnosis was established by surface electrocardiograms recorded during sinus rhythm and tachycardia, and by complete cardiac electrophysiologic studies. The location of accessory pathways (AP) were: 4 left lateral, 3 right lateral, 1 right posteroseptal and 1 right anteroseptal AV groove. In all 6 patients with manifest WPW syndrome, the location of AP could be correctly predicted by the surface EKG delta wave polarity. In all 9 patients with WPW syndrome, intraoperative epicardial and endocardial mappings confirmed their location. Wide endocardial dissection were undertaken. No surgical morbidities or mortality was encoundtered except in one case which developed transient postpericardiotomy syndrome. During the follow-up (2 to 4 years), all of them were in sinus rhythm, drug free and tachycardia free. In conclusion, (a) the sites of AP and the arrhythmia mechanisms can be reliably predicted by surface EKG and catheter mapping techniques; (b) surgical cure of supraventricular tachycardia could be achieved safely in children; and (c) surgical ablation still is indicated when catheter ablation is unsuccessful, or when coexistent complex cardiac pathology requires. surgical intervention in small children.

並列關鍵字

supraventricular tachycardia ； Wolff-Parkinson-White syndrome ； endocardial dissection

國際替代計量

Surgical Ablation of Wolff – Papkinson - White Syndrome in Children and Young Adults

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