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Abstract：
Although a hybrid procedure involving surgical access may be feasible for epicardial catheter ablation in individuals with prior cardiac surgery, surgical approaches in thoracotomy are important in patients with advanced adhesions. We performed an epicardial ventricular tachycardia (VT) ablation in a patient with dilated phase hypertrophic cardiomyopathy after left ventricular reconstruction. We gained surgical epicardial access via lateral thoracotomy based on the anticipated VT circuit in the apical anteroseptal area, which was estimated using prior endocardial mapping. The remaining epicardial myocardium around the surgical incision was involved in the central isthmus, and the VT was eliminated by radiofrequency catheter ablation. .
摘要：
尽管涉及手术入路的混合手术对于曾进行过心脏手术的患者的心外膜导管消融可能是可行的。对于晚期粘连患者，开胸手术方法很重要。我们在左心室重建后对扩张期肥厚型心肌病患者进行了心外膜室性心动过速（VT）消融。我们根据预期的心尖前间隔区的VT回路，通过侧胸切开术获得了心外膜手术入路，这是使用先前的心内膜标测进行估计的。手术切口周围剩余的心外膜心肌累及中央峡部，室性心动过速通过射频导管消融术消除。学习目标：有心脏手术史的患者术后粘连阻碍了剑突下穿刺经皮导管入路。结合计算机断层扫描成像的解剖学考虑和心内膜消融的信息，有助于进行微创手术心外膜入路。假定手术切口周围的剩余心外膜心肌涉及室性心动过速的折返回路，该患者被诊断为扩张期肥厚型心肌病，先前有左心室重建史。>.
