SURGICAL-TREATMENT OF PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME AND ASSOCIATED EBSTEINS-ANOMALY

Ebstein's anomaly is the most common congenital heart disease associat ed with the Wolff-Parkinson-White syndrome. Between November 1973 and March 1993, we surgically treated 42 patients with Wolff-Parkinson-Whi te syndrome and Ebstein's anomaly. The patients' ages ranged from 5 mo nths 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 pos teroseptal (29%) area, A left-sided accessory pathway was seen in only two patients (3.8%). Division of all right-sided accessory pathways w as done during normothermic cardiopulmonary bypass with the heart beat ing; cryocoagulation was applied together with scalpel dissection of t he atrioventricular groove, Division of the left-sided accessory pathw ays was done with the use of cold potassium cardioplegic arrest. Thirt y-five of these patients underwent tricuspid valve operation for Ebste in'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 cau sed by accessory pathways in different positions. Three hospital death s (7.1%) occurred, There were no late deaths during the follow-up peri od (mean 94.3 +/- 52.4 months), but two patients required repeat tricu spid 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, correctio n should be indicated in some patients.