心房纤维颤动的外科治疗

Surgical Treatment of Atrial Fibrillation

3例采用改良迷宫术探索进行心房纤颤外科治疗获成功。病人术前均为风湿性心脏病,心功能Ⅲ～Ⅳ级,心房纤颤病史3～10年,左房直径52～58mm,心胸比率0.64～0.70。在进行改良迷宫术的同时,2例行二尖瓣替换,1例行双瓣替换及三尖瓣环缩。术后2例自动复跳,1例电击除颤复跳。3例术后早期均为窦性心律。2例术后3年恢复良好,正常心律,心功能Ⅰ级;1例术后3个月死于脑血管意外。文中重点介绍了手术方法,提出了手术适应证,探讨了改良迷宫术的理论基础。

This paper presents successful surgical treatment of a-trial fibrillation by a simplified maze procedure (SMP) in 3 patients. All of them suffered from rheumatic heart valvular diseases complicated with atrial fibrillation (AF) for 3 to 10 years. Their heart function were in class III-IV(NYHA). The diameter of the left atrium varied from 52-58 mm and the cardiothoracic ratio 0. 64-0.70. The open heart operation was performed under conventional cardiopulmonary bypass combined with systemic hypothermia and using cardio-plegia for myocardial protection. After finishing the modified maze operation,mitral valve replacement was performed in 2 cases and mitral and aortic valve replacement together with tricuspid annuloplasty in one. Sinus rhythm recovered after cardiac ressuscitation and was maintained in the early postoperative period in all 3 cases. However, with in 3 months after the operation, one patient died of cerebrovascular accident, probably a complication of anticoagulant therapy. The other 2 patients remained well with normal sinus rhythm and their heart function was in class I 3 years after the operation. The clinical results indicate that mitral valve or mitral and aortic valve replacements plus simplified maze procedure to abolish atrial fibrillation may improve the postoperative hemodynamics by recovery of the sinus rhythm.