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J Thorac Cardiovasc Surg 1996;111:1292
© 1996 Mosby, Inc.

LETTERS TO THE EDITOR

Surgical technique and atrial arrhythmias after total cavopulmonary connection

Kazuhiro Hashimoto, MD, Hiromi Kurosawa, MD

Department of Cardiovascular Surgery
Jikei University School of Medicine
3-25-8, Nishishinbashi, Minatoku
Tokyo, Japan

Reply to the Editor:

Our conclusion regarding the prevention of postoperative arrhythmias was based on clinical evidence, Holter electrocardiograms, and p trigger–signal averaged electrocardiograms (seeTable V in the article). Those data all negatively supported the prevalence of atrial arrhythmias after the repair with our technique. However, we do not have other data that Dr. Gandhi and associates probably consider important factors in the development of atrial arrhythmias.

For the atrial incision, we made a longitudinal incision along the sulcus terminalis in the right atrial free wall, at least 2 to 3 cm away from the crista terminalis, as in the Senning operation. Thus we assume that the incision could not create conduction block in the vicinity of the crista terminalis and could not alter the longitudinal conduction along it. The superior incision of the atriotomy used in our technique never approaches the sinoatrial node, because it extends beneath the medial aspect of the superior vena cava. Therefore, injury to the sinoatrial node is always preventable.





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