Cryosurgery for ventricular bigeminy using a transaortic closed ventricular approach
Identifieur interne : 002920 ( Istex/Curation ); précédent : 002919; suivant : 002921Cryosurgery for ventricular bigeminy using a transaortic closed ventricular approach
Auteurs : F. E. E. Vermeulen ; N. M. Van Hemel ; G. M. Guiraudon [Pays-Bas] ; J. J. A. M. Defauw ; H. R. J. Elbers [Canada] ; J. M. T. De Bakker [Pays-Bas] ; F. J. L. Van Cappelle [Pays-Bas]Source :
- European Heart Journal [ 0195-668X ] ; 1988-09.
Abstract
Disabling monomorphic ventricular bigeminy has not been described as an indication for surgery. Three young patients with this arrhythmia sometimes deteriorating into ventricular tachyarrhythmias and in whom drug therapy failed completely were accepted for surgical ablation of the arrhythmogenic area. The earliest endocardial site of origin was located preoperatively by catheter mapping of the spontaneously occuring ventricular bigeminy in the left and right ventricles. For maximum preservation of myocardial muscle and function, the peroperative mapping and surgical procedure were preformed through the aortic root; mapping by transaortic multipolar balloon was done during normothermic coronary perfusion and cryocoagulation was done during cardioplegic arrest. Cryocoagulation of the endocardial site was performed using the transaortic approach and epicardial cryocoagulation at the opposite site was done afterwards. In the two patients in whom the peroperative mapping results were consistent with those of preoperative catheter mapping, the arrhythmia could be abolished, as documented during long-term follow-up. In the only patient in whom the mapping results were not in agreement, the ventricular arrhythmia reoccurred and was the cause of death at five months after surgery. Postoperative wall-motion studies performed in the two surviving patients showed limited scars in the area of cryocogulation and minor damage to the coronary arteries in that area. The transaortic approach can be considered as a new and important surgical option for endocardial mapping and cryocoagulation which prevents the damaging effects of a left ventriculotomy.
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DOI: 10.1093/oxfordjournals.eurheartj.a062603
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F. E. E. Vermeulen<affiliation><mods:affiliation>Department of Cardiothoracic Surgery</mods:affiliation><wicri:noCountry code="no comma">Department of Cardiothoracic Surgery</wicri:noCountry></affiliation><affiliation><mods:affiliation>†Cardiology</mods:affiliation><wicri:noCountry code="no comma">†Cardiology</wicri:noCountry></affiliation><affiliation><mods:affiliation>Department of Cardiothoracic Surgery</mods:affiliation><wicri:noCountry code="no comma">Department of Cardiothoracic Surgery</wicri:noCountry></affiliation>Le document en format XML
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Guiraudon</name><affiliation wicri:level="1"><mods:affiliation>§Clinical Pathology, St Antonius Hospital Nieuwegein/Utrecht, The Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>§Clinical Pathology, St Antonius Hospital Nieuwegein/Utrecht</wicri:regionArea></affiliation></author><author><name sortKey="Defauw, J J A M" sort="Defauw, J J A M" uniqKey="Defauw J" first="J. J. A. M." last="Defauw">J. J. A. M. Defauw</name><affiliation><mods:affiliation>Department of Cardiothoracic Surgery</mods:affiliation><wicri:noCountry code="no comma">Department of Cardiothoracic Surgery</wicri:noCountry></affiliation></author><author><name sortKey="Elbers, H R J" sort="Elbers, H R J" uniqKey="Elbers H" first="H. R. J." last="Elbers">H. R. J. Elbers</name><affiliation wicri:level="1"><mods:affiliation>‡Department of Surgery, University Hospital, University of Western Ontario London, Ontario, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>‡Department of Surgery, University Hospital, University of Western Ontario London, Ontario</wicri:regionArea></affiliation></author><author><name sortKey="De Bakker, J M T" sort="De Bakker, J M T" uniqKey="De Bakker J" first="J. M. T." last="De Bakker">J. M. T. De Bakker</name><affiliation wicri:level="1"><mods:affiliation>∥Department of Experimental Cardiology, Medical Center Amsterdam, State University Amsterdam The Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>∥Department of Experimental Cardiology, Medical Center Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Van Cappelle, F J L" sort="Van Cappelle, F J L" uniqKey="Van Cappelle F" first="F. J. L." last="Van Cappelle">F. J. L. Van Cappelle</name><affiliation wicri:level="1"><mods:affiliation>∥Department of Experimental Cardiology, Medical Center Amsterdam, State University Amsterdam The Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>∥Department of Experimental Cardiology, Medical Center Amsterdam</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:9D7EF2D250E35474F91A80FA7214A294759259B6</idno><date when="1988" year="1988">1988</date><idno type="doi">10.1093/oxfordjournals.eurheartj.a062603</idno><idno type="url">https://api-v5.istex.fr/document/9D7EF2D250E35474F91A80FA7214A294759259B6/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002920</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">002920</idno><idno type="wicri:Area/Istex/Curation">002920</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Cryosurgery for ventricular bigeminy using a transaortic closed ventricular approach</title><author><name sortKey="Vermeulen, F E E" sort="Vermeulen, F E E" uniqKey="Vermeulen F" first="F. 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Guiraudon</name><affiliation wicri:level="1"><mods:affiliation>§Clinical Pathology, St Antonius Hospital Nieuwegein/Utrecht, The Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>§Clinical Pathology, St Antonius Hospital Nieuwegein/Utrecht</wicri:regionArea></affiliation></author><author><name sortKey="Defauw, J J A M" sort="Defauw, J J A M" uniqKey="Defauw J" first="J. J. A. M." last="Defauw">J. J. A. M. Defauw</name><affiliation><mods:affiliation>Department of Cardiothoracic Surgery</mods:affiliation><wicri:noCountry code="no comma">Department of Cardiothoracic Surgery</wicri:noCountry></affiliation></author><author><name sortKey="Elbers, H R J" sort="Elbers, H R J" uniqKey="Elbers H" first="H. R. J." last="Elbers">H. R. J. Elbers</name><affiliation wicri:level="1"><mods:affiliation>‡Department of Surgery, University Hospital, University of Western Ontario London, Ontario, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>‡Department of Surgery, University Hospital, University of Western Ontario London, Ontario</wicri:regionArea></affiliation></author><author><name sortKey="De Bakker, J M T" sort="De Bakker, J M T" uniqKey="De Bakker J" first="J. M. T." last="De Bakker">J. M. T. De Bakker</name><affiliation wicri:level="1"><mods:affiliation>∥Department of Experimental Cardiology, Medical Center Amsterdam, State University Amsterdam The Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>∥Department of Experimental Cardiology, Medical Center Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Van Cappelle, F J L" sort="Van Cappelle, F J L" uniqKey="Van Cappelle F" first="F. J. L." last="Van Cappelle">F. J. L. Van Cappelle</name><affiliation wicri:level="1"><mods:affiliation>∥Department of Experimental Cardiology, Medical Center Amsterdam, State University Amsterdam The Netherlands</mods:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>∥Department of Experimental Cardiology, Medical Center Amsterdam</wicri:regionArea></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="1988-09">1988-09</date><biblScope unit="volume">9</biblScope><biblScope unit="issue">9</biblScope><biblScope unit="page" from="979">979</biblScope><biblScope unit="page" to="990">990</biblScope></imprint><idno type="ISSN">0195-668X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Disabling monomorphic ventricular bigeminy has not been described as an indication for surgery. Three young patients with this arrhythmia sometimes deteriorating into ventricular tachyarrhythmias and in whom drug therapy failed completely were accepted for surgical ablation of the arrhythmogenic area. The earliest endocardial site of origin was located preoperatively by catheter mapping of the spontaneously occuring ventricular bigeminy in the left and right ventricles. For maximum preservation of myocardial muscle and function, the peroperative mapping and surgical procedure were preformed through the aortic root; mapping by transaortic multipolar balloon was done during normothermic coronary perfusion and cryocoagulation was done during cardioplegic arrest. Cryocoagulation of the endocardial site was performed using the transaortic approach and epicardial cryocoagulation at the opposite site was done afterwards. In the two patients in whom the peroperative mapping results were consistent with those of preoperative catheter mapping, the arrhythmia could be abolished, as documented during long-term follow-up. In the only patient in whom the mapping results were not in agreement, the ventricular arrhythmia reoccurred and was the cause of death at five months after surgery. Postoperative wall-motion studies performed in the two surviving patients showed limited scars in the area of cryocogulation and minor damage to the coronary arteries in that area. The transaortic approach can be considered as a new and important surgical option for endocardial mapping and cryocoagulation which prevents the damaging effects of a left ventriculotomy.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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