Epicardial electric shock ablation of the left lateral accessory pathway.

Fifty patients with drug-resistant, recurrent tachyarrhythmias causing Wolff-Parkinson-White syndrome underwent surgery between 1990 and 1992. All recognized surgical methods for accessory pathway destruction were performed. Epicardial electric shock ablation was first used as a method of surgically destroying an accessory atrioventricular pathway in 1983. This technique avoids the need for cardioplegia and hypothermia during operation. The procedure is based on the application of a series of two to five electrical shocks (50-150 J) to the region of the atrioventricular groove where the accessory pathway has been previously located. Some 32 patients with a left free wall accessory pathway underwent this operation. Cardioplegia and hypothermia were not required in 22 patients with an accessory pathway located in the left lateral position. In the second group comprising ten patients with a left lateral accessory pathway, four were diagnosed as having a second pathway and four had concomitant heart pathology such as coronary artery disease -- one had an atrial septal defect and another had a ventricular septal defect. Accessory pathway ablation was carried out in these ten patients using epicardial electric shock under normothermic cardiopulmonary bypass. Concomitant heart pathology was corrected at the second stage of the operation under cardiopulmonary bypass with cardioplegia and hypothermia. Postoperative electrophysiological studies confirmed that the accessory pathway had been destroyed in all patients. The only side effects of epicardial electric shock application were transient ST elevation < 1 mm in four patients, transient atrioventricular bloc in two and moderate sinus tachycardia in three.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute mitral regurgitation caused by penetrating chest injury.

A 22-year-old male patient with penetrating cardiac injury was admitted to general surgery, where he underwent an immediate, life saving operation. Subsequent cardiological evaluation established the presence of a well tolerated mitral regurgitation without the need for urgent cardiac surgical intervention. One month later the patient was re-admitted in cardiac failure. Transesophageal echocardiography suggested the detachment of the posterior leaflet, which was not previously demonstrated by transthoracic echocardiography. Emergency surgery confirmed the diagnosis and the mitral valve was successfully repaired. The postoperative course was uneventful. This case history suggests that transesophageal echocardiography is mandatory after penetrating cardiac injury even in the case of good clinical condition and negative transthoracic echocardiographic findings. In the presence of valvular injury, early surgical intervention is recommended.

Surgery as an effective nonpharmacological mode of treatment of atrial fibrillation resistant to standard therapy.

There are two surgical methods for atrial fibrillation (AF) treatment: Maze and corridoring procedures. The first one prevents AF occurrence by performing multiple atriotomies. During the second procedure a corridor between a sino-atrial and the AV node is created together with an electrical isolation of the atria. During 1992 and 1993 seven patients, aged 27-55, mean 43-years-old, with recurrent, resistant to standard therapy AF were referred for surgical treatment to our department. Additional diagnoses include: concealed WPW syndrome in 1 patient, atrial septal defect (ASD) in 3 patients, coronary artery disease in 1 patient. Maze procedure was performed solely in 1 patient, in another together with 2 accessory pathways ablation, in 3 patients with ASD closure and in 1 patient with 2 bypass grafts. In one patient corridoring procedure was performed. Normal sinus rhythm was restored in every patient from 7 to 26 days after the procedure. No surgical complications were noted during the postoperative period. Mechanical function of the atria was documented with echo Doppler 2-6 weeks after the operation. No evidence for AF recurrence was noted within 3-14 months (mean 5 months) of follow-up. The preliminary results of Maze and corridoring procedures are encouraging.

[Treatment of 3 patients with arrhythmias using "radiofrequency" ablation]. / Leczenie 3 chorych z zaburzeniami rytmu serca metada "radiofrequency".

In 3 patients radiofrequency (RF) ablation of AV node (n = 2) and left sided accessory pathway (n = 1) was performed because of intractable tachyarrhythmias. RF ablation was made in the first patient (ablation of AV node) using 135 Watts during 72 sec., in the second patient (AV node ablation) 331 Watts during 185 sec., and in the last patient 883 Watts during 695 sec. In the last patient ablation of accessory pathway was unsuccessful and the patient has been successfully operated. AV conduction was interrupted in 2 cases. No complications were noted. General anesthesia was not required. All the patients were discharged in a good state.

[Cor triatriatum with mitral incompetence--contribution to diagnosis and therapy]. / Serce trójprzedsionkowe z niedomykalnoscia zastawki dwudzielnej--przyczynek do diagnostyki i terapii.

Authors presented difficulties in diagnosis of the cor triatriatum with the mitral incompetence in 34 years old female patient. Diagnosis was based on two-dimensional and doppler echocardiographic examinations and then angiocardiographically proved. Therapy consisted in resection of the fibromuscular intraatrial septum and implantation of the St. Jude mitral prosthetic valve.