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J Thorac Cardiovasc Surg 1995;110:1702-1707
© 1995 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

SURGICAL TREATMENT OF PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME AND ASSOCIATED EBSTEIN'S ANOMALY

Toyama and Kanazawa, Japan

Received for publication Feb. 10, 1994. Accepted for publication April 6, 1995. Address for reprints: Takuro Misaki, MD, Department of Surgery (1), Toyama Medical and Pharmaceutical University, Sugitani Toyama 2630, 930-01 Japan.

Abstract

Ebstein's anomaly is the most common congenital heart disease associated with the Wolff-Parkinson-White syndrome. Between November 1973 and March 1993, we surgically treated 42 patients with Wolff-Parkinson-White syndrome and Ebstein's anomaly. The patients' ages ranged from 5 months to 59 years (mean 35.3±14.0 years). There were a total of 52 accessory pathways, 48 of which were located in the right (65%) or posteroseptal (29%) area. A left-sided accessory pathway was seen in only two patients (3.8%). Division of all right-sided accessory pathways was done during normothermic cardiopulmonary bypass with the heart beating; cryocoagulation was applied together with scalpel dissection of the atrioventricular groove. Division of the left-sided accessory pathways was done with the use of cold potassium cardioplegic arrest. Thirty-five of these patients underwent tricuspid valve operation for Ebstein's anomaly and 11 of them underwent tricuspid valve replacement with a bioprosthesis. All 52 accessory pathways were successfully divided, although two patients required reoperation because of tachycardia caused by accessory pathways in different positions. Three hospital deaths (7.1%) occurred. There were no late deaths during the follow-up period (mean 94.3±52.4 months), but two patients required repeat tricuspid operation because of progression of the tricuspid regurgitation. Because no repeat operations were required during long-term follow-up in patients who underwent valve repair or valve replacement, correction should be indicated in some patients. (J THORAC CARDIOVASC SURG 1995;110:1702-7)

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