RESUMEN
Much importance is attached lately to the use of lasers in surgical treatment of tachyarrhythmias. The advantages of the laser radiation are as follows: the possibility of using it on a contracting heart, its exact and selective effect, infliction of even damages in preservation of the structure, reduction of damage to the myocardium as a whole. At the Bakulev Institute of Cardiovascular Surgery, USSR AMS, 52 operations were carried out in the management of supraventricular tachyarrhythmias by laser radiation: 27 operations for laser isolation of the atrioventricular node, 15 operations for laser isolation of the atria and bases of the pulmonary veins (11 in combination with laser isolation of the atrioventricular node), 3 operations for ablation of ectopic foci in the atria and ventricles, 4 operations for ablation of the bundle of His, and 3 operations for removal of Maheim's nodoventricular tract. Among the patients who were operated on, 12 had atrial flutter, 21--atrial fibrillation, 11--paroxysmal atrioventricular nodal tachycardia, 5--ectopic supraventricular tachycardia, and 3 patients had paroxysmal tachycardia due to the presence of Maheim's nodoventricular tract. The method of laser isolation of the atrioventricular node was developed. It is performed on a working heart under conditions of normothermal extracorporeal circulation by Nd-YAG laser radiation under electrophysiological control. Antegrade conductivity was reduced to 420-510 msec. Among 56 patients who underwent operation 39 had sinus rhythm, 10 had Degree II-III block, and 7 patients had a recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Terapia por Láser , Taquicardia Supraventricular/cirugía , Adolescente , Adulto , Arritmias Cardíacas/cirugía , Niño , Preescolar , Femenino , Humanos , Coagulación con Láser , Masculino , Persona de Mediana EdadRESUMEN
The paper deals with the procedures and techniques of the non-invasive topical ECG diagnosis of the Wolff-Parkinson-White syndrome, which were based on the regression analysis. Based on the analysis of ECG data and the results of intraoperative cardiac mapping in 64 patients operated on for the Wolff-Parkinson-White syndrome, a linear regression model was developed, which precisely localizes the site of the Kent bundle from the measurements of delta-wave amplitude and polarity in 12 standard leads. The site of the Kent bundle was determined by 30 zones of the atrioventricular sulcus. The model represented a linear statistical dependence of the zone number of the atrioventricular sulcus on the delta-wave amplitude. Its parameters were evaluated from the data obtained in the training group of 47 patients and the accuracy of the diagnosis was assessed from the data obtained in 17 controls. The testing of the model showed that the Kent bundle may be localized at an accuracy (0.79 +/- 0.16), on an average, no greater than 1 zone. The estimation error was no more than 1 zone in 88% of the cases and 2 zones in 12%. The proposed model may be widely used in in- and outpatient care, as its application requires no cost-effective equipment and computer facilities.
Asunto(s)
Electrocardiografía/métodos , Sistema de Conducción Cardíaco/fisiopatología , Modelos Cardiovasculares , Síndrome de Wolff-Parkinson-White/diagnóstico , Adolescente , Adulto , Niño , Femenino , Humanos , Cuidados Intraoperatorios , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis de Regresión , Síndrome de Wolff-Parkinson-White/fisiopatología , Síndrome de Wolff-Parkinson-White/cirugíaRESUMEN
The paper deals with the problems in the diagnosis and treatment of patients with the most malignant rhythm disturbances, i. e. ventricular arrhythmias. A great emphasis is laid on the so-called "primary" arrhythmias appearing without a manifest cardiac abnormality. The arrhythmias proceed unfavorably and are followed by profound morphofunctional myocardial changes occurring chiefly in the upper portions of the ventricular septum, more frequently on the right. Cryodestruction of arrhythmogenic areas is an effective method for surgical correction of arrhythmias having an unfavorable course.