改良迷宫手术治疗二尖瓣疾病伴慢性心房颤动

Modified Maze Procedure for Chronic Atrial Fibrillation Associated with Mitral Valve Disease

目的介绍一种治疗二尖瓣疾病伴慢性心房颤动的改良迷宫手术。方法对１５例作二尖瓣替换手术的患者同时施行改良迷宫手术，常规建立体外循环及心肌保护。房顶和房间隔联合切口完成后作绕肺静脉口的环形切口。－６０℃，２分钟冷冻环形切口左下至二尖瓣后瓣环中点及环形切口左上至左心耳开口之间的区域。连续缝合环形切口，替换二尖瓣。连续缝合左房顶和房间隔，开放主动脉后关闭右心房切口及切除左心耳。结果所有患者术后均康复出院。除二尖瓣替换外尚有５例行左心房血栓清除，３例行三尖瓣环缩。出院随访１～５月（平均３月），１５例患者均恢复为窦性心律。结论与ｍａｚｅ－Ⅲ手术相比我们所采用的改良迷宫手术技术较为简便，亦安全可行。

Objective To describe a modified maze procedure for chronic atrial fibrillation associated with mitral valve disease. Methods Fifteen patients underwent mitral valve replacement in combination with a modified maze procedure. Among the patients, there were four male and eleven female, aged 24-59 years (mean 41 years). Five patients had mitral stenosis, four had mitral regurgitation, and six had a mixed mitral lesion. The atrial fibrillation duration varied from 4 months to 12 years (mean 5 years). The ratio of cardiothorax ranged from 0.56 to 0.78 (mean 0.65). Cardiopulmonary bypass was initiated and the heart was arrested with cold crystalloid cardioplegia as usual. Having finished combined superior transseptal approach, a standard left atriotomy was extended to encircle the orifices of the pulmonary veins. Cryoablation at -60℃ for 2 minutes was directed toward from the encircling incision to the posterior mitral valvular annulus and to the orifice of left atrial appendage respectively. The encircling incision was closed with a continous 3 0 prolene suture. Mitral valve was replaced with prosthetic valve and the incisions of the atrial septum and the doom of the left atrium were closed with a continous 3 0 prolene suture. After removing cross clamping the incision of the right atrium was closed and the left atrial appendage was excised. Results All patients recovered and were discharged after operations. In addition, the left atrial thrombi was removed from 5 patients and DeVega tricuspid annuloplasty was performed on 3 patients. The follow up time varied from 1 to 5 months (mean 3 months). All patients recovered sinus rhythm. Conclusion Compared with maze Ⅲ, the modified maze procedure described by us is comparatively simpler, safer and more practicable. However the long term results needs further observation.