Experience with 118 consecutive patients undergoing operation for the Wolff-Parkinson-White syndrome.
Experience with 118 consecutive patients undergoing operation for the Wolff-Parkinson-White syndrome.
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连续 118 名沃尔夫-帕金森-怀特综合征患者接受手术的经验。
DOI：
10.1016/s0022-5223(19)38561-7
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
M. Cain
中科院分区：
文献类型：
--
作者：
J. Cox;J. Gallagher;M. Cain
从1980年7月1日至1985年4月1日，118例患者接受手术矫正Wolff-Parkinson-白色综合征。男72例，女46例，年龄9个月~ 70岁，平均（28 ± 6）岁。主要手术指征为内科难治性或药物不耐受（60%）和既往心脏骤停（14%）.相关异常包括Ebstein异常（12%）、其他心律失常（34%）、冠状动脉疾病（6%）、心肌病（6%）和Ebstein异常以外的先天性心脏病（22%）。2例患者曾在其他机构接受过Wolff-Parkinson-白色综合征手术。20%的患者有多条（2 - 4条）旁道，118例患者中共有149条旁道。旁道分布如下：左侧游离壁58%，后间隔24%，右侧游离壁13%，前间隔5%。1981年8月，对以前治疗Wolff-Parkinson-白色综合征和本系列中前10例患者所采用的手术技术进行了修改，包括（1）2.5倍光学放大，（2）在心脏停搏下仅使用内镜入路，（3）更宽的外科解剖边缘，（4）对受累瓣膜环进行锐性解剖，（5）仅分离旁路的心室插入，和（6）在所有解剖区域中的心室心外膜剥离的内部识别。在118例患者中，148例成功分离了149条旁路，通过上述修改，在该系列的最后108例患者中，137条旁路中的137条成功分离。这些患者的手术结果记录了旁路分离的成功率从86%增加到99.3%，再手术率从约15%降低到0%，永久性完全性心脏传导阻滞的发生率从10.5%降低到0.8%。整个系列的死亡率为5.0%，但只有1例在没有相关心脏异常的情况下在择期手术后死亡（0.8%）。使用目前的手术技术，这些结果表明，手术治疗是一个保守的替代终身的药物治疗的年轻，否则健康的沃尔夫-帕金森-白色综合征患者。
Between July 1, 1980, and April 1, 1985, 118 patients underwent operation for correction of the Wolff-Parkinson-White syndrome. There were 72 male and 46 female patients with ages ranging from 9 months to 70 years (mean 28 ± 6 years). The major indications for operation were medical refractoriness or drug intolerance (60 %) and previous cardiac arrest (14 %). Associated abnormalities included Ebstein’s anomaly (12%), other arrhythmias (34%), coronary artery disease (6%), cardiomyopathy (6%), and congenital heart disease other than Ebstein’s anomaly (22%). Two patients had undergone operations for Wolff-Parkinson-White syndrome previously at other institutions. Twenty percent of patients had multiple (two to four) accessory pathways, a total of 149 pathways being present in the 118 patients. Distribution of the accessory pathways was as follows: 58% left free wall, 24% posterior septal, 13% right free wall, and 5% anterior septal. The surgical technique employed previously for the Wolff-Parkinson-White syndrome and for the first 10 patients in the present series was modified in August, 1981, to include (1) 2.5 power optical magnification, (2) exclusive use of the endocardial approach under cardioplegic arrest, (3) wider margins of surgical dissection, (4) sharp dissection of the involved valve anulus, (5) division of only the ventricular insertion of the accessory pathway, and (6) internal identification of the ventricular epicardial peel in all regions of dissection. Of the 149 accessory pathways present, 148 were successfully divided in the 118 patients and, by means of the above modifications, 137 of 137 accessory pathways have been divided successfully in the last 108 patients in the series. The surgical results in these patients document an increase in the success rate for division of accessory pathways from 86 % to 99.3 %, a decrease in the reoperation rate from approximately 15 % to 0 %, and a decrease in the incidence of permanent complete heart block from 10.5 % to 0.8 %. The mortality was 5.0 % in the entire series, but only one death occurred following elective operation in the absence of associated cardiac abnormalities (0.8 %). Using the present surgical technique, these results suggest that surgical therapy is a conservative alternative to a lifetime of medical therapy in young, otherwise healthy patients with the Wolff-Parkinson-White syndrome.
DOI：
10.1016/0002-9149(82)90296-x
发表时间：
1982
期刊：
The American journal of cardiology
影响因子：
--
作者：
Gallagher,JJ;Kasell,JH;Cox,JL;Smith,WM;Ideker,RE;Smith,WM
通讯作者：
Smith,WM