The Annals of Thoracic Surgery, Vol 36, 180-186, Copyright © 1983 by The Society of Thoracic Surgeons
Kent bundles in the anterior septal space
WC Sealy
Kent bundles in the anterior septal area of the heart occupy a region of
complex morphology. In this study, the anatomical characteristics of the
area were reviewed by the dissection of 12 human hearts and then an
analysis was done of the results of operation in 15 patients with Kent
bundles in this location. One important anatomical finding was the
relationship of the atrial septum, the right fibrous trigone, and the
underlying membranous ventricular septum to the atrioventricular node and
the His bundle. The normal components of the conduction system are
protected from injury at operation by encasement in these structures. At
operation, the accuracy with which retrograde endocardial mapping could
identify the Kent bundle was demonstrated in 8 patients who had Kent
bundles clearly shown to be within 2 to 5 mm of the His bundle. Kent bundle
interruption in 13 patients was achieved by a precisely placed incision and
dissection, and in 2 patients by cryothermia. In 1 of these 2 patients,
both the His bundle and the Kent bundle were interrupted when cryothermia
was used at a second operation. This study indicates that a Kent bundle and
His bundle can be within 2 mm of each other, judging their positions by
retrograde endocardial mapping. Final proof of the Kent bundle's location
is demonstrated by interruption. With the protection afforded to the His
bundle by encasement in the right fibrous trigone, surgical interruption of
the adjacent Kent bundle can be accomplished without injury to the His
bundle.
