Results of intervention and surgical treatment of Wolff-Parkinson- White syndrome in patients with Ebstein's anomaly
Objective. To prove the choice of an optimum method of surgical treatment of Wolff-Parkinson-White (WPW) syndrome in patients with Ebstein's anomaly and also to estimate the immediate and remote results. Material and methods. The research included 54 patients with Ebstein's anomaly and Wolff- Parkinson-White syndrome in whom the additional atrioventricular connections were eliminated in one stage with correction of the main defect (Sealy operation, cryodestruction) or by means of a radiofrequency ablation in Bakoulev Center from 2006 to 2016. The age of investigated persons was from 2 to 58 years. Patients were divided into two groups. Those in whom correction of Ebstein's anomaly was carried out (the operated patients) were included in Group 1. It, in turn, was divided into two subgroups: Subgroup 1 included patients to whom one-stage correction of Ebstein's anomaly and WPW syndrome was perfomed (Sealy operation, cryodestruction), Subgroup 2 consisted of patients in whom radiofrequency ablation was carried out before or after correction of Ebstein's anomaly. Group 2 included patients for whom, according to hemodynamic indications, correction of Ebstein's anomaly was not required (not operated patients). Elimination of additional atrioventricular connections in this group was carried out by means of interventional treatment. Results. Efficiency of interventional treatment taking into account repeated ablation of WPW syndrome in patients with Ebstein's anomaly was 93.33%, at one-stage surgical treatment of WPW syndrome and correction of Ebstein's anomaly - 87.5%, with zero lethality in both groups. Conclusion. A recurrence of tachycardia arises both at interventional treatment of WPW syndrome in patients with Ebstein's anomaly, and at one-stage surgical treatment. Most often a recurrence of tachycardia is observed at multiple and septal additional atrioventricular connections. However when choosing tactics of surgical treatment it is necessary to be guided by hemodynamic and anatomic changes of defect, and also to consider age of the patient. Rather high rates of efficiency of interventional treatment and also an opportunity at a recurrence of tachycardia of carrying out repeated ablation with minimal risk of complications for the patient, are essential advantage. And also it is necessary to emphasize the reduction of time of cardiopulmonary bypass and aortic clamping during Ebstein's anomaly correction, after elimination of additional atrioventricular connections by means of radiofrequency ablation.