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[Surgery for Wolff-Parkinson-White syndrome in the first year of life]
F A Fantini1, E B Sternick, B Gontijo Filho
1Biocor Hospital de Doenças Cardiovasculares, Nova Lima, MG.
Insights
Surgical treatment successfully addressed reentrant atrioventricular tachycardia in an infant using an endocardial technique. The child recovered well, remaining free of tachycardia with normal heart function at 18 months.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Surgical Treatment
Background:
- Reentrant atrioventricular tachycardia (AVT) can cause hemodynamic instability in infants.
- Pharmacological management of AVT in pediatric patients is often challenging.
- Concealed accessory pathways are a common cause of AVT.
Observation:
- A 7-month-old infant presented with repetitive, drug-refractory atrioventricular tachycardia (AVT).
- Electrophysiologic study identified a concealed accessory pathway in the anterior septal region of the tricuspid annulus.
- The infant experienced transient right ventricular dysfunction and ventricular fibrillation post-surgery.
Findings:
- Successful surgical ablation of the accessory pathway was achieved using an endocardial approach.
- Ischemic-like episodes, potentially due to coronary artery spasm, were managed with isosorbide dinitrate.
- The patient remained free of AVT and maintained normal atrioventricular conduction at 18-month follow-up.
Implications:
- Endocardial surgical techniques offer a viable treatment for pediatric AVT caused by concealed accessory pathways.
- Close monitoring for and prompt management of potential postoperative complications like right ventricular dysfunction and coronary artery spasm are crucial.
- Successful surgical intervention can lead to long-term freedom from tachycardia and normal cardiac function in affected children.
Abstract:
A case of surgical treatment for reentrant atrioventricular tachycardia in a 7 months old child is reported. Episodes of tachycardia were repetitive and long-lasting, often leading to signs of hemodynamic impairement, and were not controlled by antiarrhythmic drugs. The electrophysiologic study showed a circus-movement tachycardia utilizing a concealed accessory pathway located at the anterior septal aspect of tricuspid anulus. The child underwent successful surgical treatment by the endocardial technique. Few minutes after weaning from extracorporeal circulation, developed T wave inversion followed by acute right ventricular dysfunction and ventricular fibrillation. Others ischemic like episodes, maybe as a result of coronary artery spasm, occurring in the next 6 hours were successfully treated with isosorbide dinitrate. At 18 months follow-up, the child is free of tachycardia and has normal atrioventricular conduction.