心脏不停跳下改良迷宫术加左房折叠治疗房颤瓣膜病的临床观察

The clinical observation of modified maze procedure combined with left atrium plication in beating heart for treating of atrial fibrillation with valvular heart disease

目的 评价心脏不停跳心内直视下行二尖瓣置换术与改良迷宫术同时行左房折叠术（LAP）的安全性和疗效.方法 对33例二尖瓣病变合并巨大左心房与慢性心房颤动患者,在体外循环心脏不停跳下行二尖瓣置换术的同时,采用射频消融方式实施改良迷宫术,加行左房折叠术.结果 全组无院内死亡,术后心房颤动全部消失,无房室传导阻滞、出血.随访12～36个月,其中30例维持窦性心律,心房颤动复发3例,转复率为90.9%.复查心脏超声心动图提示,左心房、左心室较术前明显缩小,心功能明显改善.无血栓复发.结论 应用心脏不停跳下改良迷宫术加左房折叠在二尖瓣病变合并巨大左心房瓣膜置换术中治疗慢性房颤,能有效消除房颤并长期维持窦律,改善左心房、室主动收缩功能,并发症少,安全简便且疗效确切,值得推广应用.

Objective To evaluate the safety and efficacy of combining mitral valve replacement with the modified maze procedure and row left atrial plication （LAP） in beating heart. Methods 33 patients with mitral valve disease combined with giant left atrium and chronic atrial fibrillation（AF） patients underwent mitral valve re-placement and modified maze procedure using radiofrequeney catheter ablation, combining with left atrial plication by cardiopulmonary bypass in beating heart. Results There has no in-hospital deaths, atrial fibrillation disap-peared postoperative in all patients, no atrioventricular conduction block and bleeding. During 12-36 months of follow-up, of which 30 cases maintained sinus rhythm, 3 cases recurrent atrial fibrillation, cardioversion rate was 90.9%. the eehocardiography showed the size of left atrium, left ventricle compared with preoperative was de-creased, heart function improved significantly. No recurrence of thrombus. Conclusion Applied left atrial modi-fied maze in giant left atrium during mitral valve replacement can effectively eliminate the AF and increase long-term maintenance of sinus rhythm, and improve left atrial, ventricular systolic function, with less complications, and show safe and simole and good efficacy.