Cryosurgery for ventricular bigeminy using a transaortic closed ventricular approach

Disabling monomorphic ventricular bigeminy has not been describedas an indication for surgery. Three young patients with thisarrhythmia sometimes deteriorating into ventricular tachyarrhythmiasand in whom drug therapy failed completely were accepted forsurgical ablation of the arrhythmogenic area. The earliest endocardialsite of origin was located preoperatively by catheter mappingof the spontaneously occuring ventricular bigeminy in the leftand right ventricles. For maximum preservation of myocardialmuscle and function, the peroperative mapping and surgical procedurewere preformed through the aortic root; mapping by transaorticmultipolar balloon was done during normothermic coronary perfusionand cryocoagulation was done during cardioplegic arrest. Cryocoagulationof the endocardial site was performed using the transaorticapproach and epicardial cryocoagulation at the opposite sitewas done afterwards. In the two patients in whom the peroperativemapping results were consistent with those of preoperative cathetermapping, the arrhythmia could be abolished, as documented duringlong-term follow-up. In the only patient in whom the mappingresults were not in agreement, the ventricular arrhythmia reoccurredand was the cause of death at five months after surgery. Postoperativewall-motion studies performed in the two surviving patientsshowed limited scars in the area of cryocogulation and minordamage to the coronary arteries in that area. The transaorticapproach can be considered as a new and important surgical optionfor endocardial mapping and cryocoagulation which prevents thedamaging effects of a left ventriculotomy.