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Ann Thorac Surg 1994;57:1675-1683
© 1994 The Society of Thoracic Surgeons

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Articles

Surgical anatomy of accessory connections of atrioventricular conduction

Department of Surgery, Mercer University School of Medicine, The Medical Center of Central Georgia, Macon, Georgia, USA

^_* Address reprint requests to Dr Sealy, Department of Surgery, Mercer University School of Medicine, The Medical Center of Central Georgia, 777 Hemlock St. Hospital Box 140, Macon, GA 31208-6000.

Forty-nine descriptions of accessory pathways of atrioventriculai (AV) conduction have been analyzed in the search for reasons for an occasional failure of interruption by operation. The validity of the steps now used for open interruption of connections was confirmed. Several possible but highly speculative reasons were found for failure. A pathway might remain intact after operation because atrial muscle on the AV valve may act as a pathway route after an atriotomy made just above the annulus. In another situation, the AV valve myocardium might be continuous with a papillary muscle directly attached to the valve. The small, middle, and great coronary veins, when budding from the coronary sinus, might carry with them an AV connection that escaped the invasion of the primitive AV junction by sulcus tissue. Final proof of these conjectures awaits more studies of hearts with accessory pathways of AV conduction.

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