体外循环心脏不停跳下瓣膜心脏病合并慢性心房颤动的外科治疗

Surgical treatment of patient with valvular heart disease and chronic atrial fibrillation by beating heart surgery during cardiopulmonary bypass

目的探讨改良迷宫术与体外循环心脏不停跳技术结合,治疗慢性心房颤动的成功率及安全性。方法采用热凝及无水酒精注射方式,对33例心脏瓣膜病变合并慢性心房颤动患者于体外循环心脏不停跳下行瓣膜置换术的同时实施改良迷宫术。结果33例全部存活,术后心房颤动全部消失;随访6～27个月,其中28例维持窦性心律,心房颤动复发5例。无房室传导阻滞,无出血及血栓复发。结论浅低温心脏不停跳心内直视下的改良迷宫术操作简单、疗效确切、安全性高,值得临床推广应用。

Objective Modify maze procedure was operated in the surgery with beating heart during cardiopulmonary bypass in order to make the surgery be more uncomplicated, protect myocardial, observe curative effect by dynamic way and develop the success and security of surgery. Methods Thirty-three patients who were valvular heart disease and chronic atrial fibrillation were treated in aortic valve replacement surgery with beating heart during cardiopulmonary bypass meanwhile operating modify maze procedure with high frequency electrotome thermocoagulation and injection of sterile 99% ethanol. Results Thirty-three patients were all alive without atrial fibrillation. Following-up 6-27 month, 28 patients maintain sinus rhythm and 5 patients recurred atrial fibrillation. No atrioventricular block, hemorrhage occur and thrombus recurred. Conclusion It＇s a good and uncomplicated operation by maze procedure by mild hypothermic beating heart surgery during cardiopulmonary bypass and it is a safe and effective technique.