Circulation, Vol 90, 264-271, Copyright © 1994 by American Heart Association
T Misaki, M Tsubota, G Watanabe, Y Watanabe, Y Matumoto, K Ishida, T Iwa and R Okada
BACKGROUND: The mechanism of ventricular tachycardia (VT) after correction
of tetralogy of Fallot (TF) is poorly understood. The purpose of this study
was to examine the histopathology of the arrhythmogenic area detected by
intraoperative mapping. METHODS AND RESULTS: The patients were three men
who underwent radical surgery for TF at age 3, 3, or 5 years, respectively.
VT developed at 8, 9, or 11 years, respectively, after surgery, and shock
developed during VT in every case. The ECG revealed monomorphic VT in two
cases and polymorphic VT in one case. Induction of VT resulted in a wide
left- axis deviation-pattern QRS with cycle lengths varying between 260 and
330 milliseconds. The VT origin was identified at the right ventricular
outflow tract (RVOT). A radical operation was performed with the patient
under cardiopulmonary bypass. On epicardial mapping, delayed activation of
the RVOT was recorded during sinus rhythm, and clockwise circus movement of
the macroreentry current during VT on the right ventricular free wall was
documented in each case. The VTs were treated successfully by surgical
resection and cryoablation of the myocardium. In every patient, histology
of the myocardial specimens showed degeneration, adiposis, fibrosis,
inflammatory cell infiltration, and scattered myocyte islets. These lesions
corresponded anatomically to the area of myocardium in which delayed
activation was evident during epicardial mapping. CONCLUSIONS: The results
of this study indicate that patients with VT after radical correction of
the TF have abnormal histopathological findings at the site of the prior
right ventriculotomy scar. These lesions were noted within the region of
delayed activation found during epicardial mapping and were found to be a
part of the reentrant circuit.
ARTICLES
Surgical treatment of ventricular tachycardia after surgical repair of tetralogy of Fallot. Relation between intraoperative mapping and histological findings
Department of Surgery, Toyama Medical and Pharmaceutical University, Japan.
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