[Correlation between localization of accessory conduction pathway and body surface maps in the Wolff-Parkinson-White syndrome (author's transl)].
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Biomedical subjects
Publications and source records attributed to T Magara.
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Of 35 patients with Wolff-Parkinson-White syndrome operated on, 5 were seen with two accesory conduction pathways each; all of these were successfully interrupted. In one patient, one accessory conduction pathway each was located in the right and left side of the heart; in the other 4, both pathways were confined to the right side. In 2 patients with unilateral (right side) multiple accessory conduction pathways, Ebstein's anomaly was also present. In 1 patient with Ebstein's anomaly, the second unilateral accessory conduction pathway was discovered intraoperatively and was successfully interrupted. The remaining 4 patients required a second operation to interrupt the other pathway. A delta wave completely different from the preoperative one appeared 4 to 10 days after interruption of the first major pathway, and the second operation was performed 14 days, 42 days, four months, or five years after the first operation. All 5 patients survived, and long-term follow-up revealed no signs of morbidity.
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We operated upon 36 patients with Wolff-Parkinson-White (WPW) syndrome between 1969 and July, 1979. The relationship between the electrocardiogram (ECG), particularly the delta wave, and localization of the accessory conduction pathway (ACP) was analyzed, and the value of preoperative examinations such as vectorcardiography, echocardiography, body surface mapping, intracavitary potential study, and cardiac pacing were demonstrated. Epicardial mapping was indispensable as an intraoperative study and represented the most effective method for localizing the ACP. In some cases, endocarial potential study was found to be efficacious. Detachment of the atrium from the ventricle by an incision along the anulus at the area of earliest pre-excitation, resulted in complete correction in 26 of 28 patients operated upon between 1973 and July, 1979. In five patients multiple ACPs was corrected, although four of them required a second operation. The surgical indications in the WPW syndrome should be expanded in view of the high success rate and the safety of the operation.
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