The surgical approach to the septal area of the heart based on experiences with 45 patients with Kent bundles.

Experience gained from interruption of 45 anterior and posterior septal Kent bundles has permitted the formulation of a safe surgical approach to the anterior and posterior divisions of the septal area. To clarify the surgical anatomy of this difficult region, the posterior space has been likened to a trihedral pyramid, toppled on its side, with the apex the right fibrous trigone, the right and left atria making two of its sides, and the muscular ventricular septum and the left ventricle or third side, the floor. The pyramidal space contains fat, the atrioventricular (AV) nodal artery, and coronary sinus. The anterior division extends from the right fibrous trigone anteriorly to the free wall. The right atrium is connected to the anulus fibrosus, which rests upon the muscular septum and infundibulum. The AV node and His bundle are protected from dissections in both divisions by the atrial septum and right fibrous trigone. The cases of 31 patients with posterior septal Kent bundles in whom interruption was attempted resulted in division in 20, forced His division in four, and failure in seven. Elective His interruption was done in three. Success occurred in the last 10. Three failures at interruption occurred in 14 anterior septal Kent bundles.