Posterior septal and right free-wall Kent pathways visualized in situ and removed at operation

This article describes the first posterior septal and first and second right free-wall pathways identified at operation for Wolff-Parkinson-White syndrome and confirmed histologically. All pathways were found in the areas of preexcitation identified by pre and intraoperative mapping. They bridged the atrium and ventricle, and postoperative electrophysiological testing confirmed division of the pathways. Kent bundles may be identified at the time of surgery but they appear to be gossamer structures usually destroyed during surgical manipulation of the coronary sulcus. Visualization of the suspected bypass tract should not alter or limit the extent of surgical dissection.