改良左房折叠术在风湿性心脏病并发心房纤颤的临床应用

Clinical value of modified left atrial plication for patients with rheumatic heart disease complicated by atrial fibrillation

目的:探讨改良左房折叠术治疗心房纤颤(房颤)的有效性。方法:210例风湿性心脏病并发房颤的患者[所有患者均因个人原因未选择瓣膜置换术中行射频消融术,各组患者术前年龄、左房内径(LAD)差异无统计学意义],在行瓣膜置换(单瓣115例,双瓣95例)的同时随机分为3组:改良组(71例,即瓣膜置换的同时行改良左房折叠术)、常规A组(对照组1,68例)和常规B组(对照组2,71例)行常规左房折叠术,术后测量患者LAD、左室射血分数(LVEF)值,观察改良左房折叠术治疗房颤的有效性。结果:术前、术后相同心脏超声平面显示改良组术后LAD显著减小,且改良组房颤转复率1月高达31%,明显高于常规A组(12%)和B组(7%)。术后12个月随访发现,改良组房颤转复率为18%,与常规A组(6%)和常规B组(4%)相比有统计学意义(P<0.05)。结论:在行瓣膜置换术的同时,改良左房折叠术作为附加术式在一定程度上可有助于转复患者房颤心律为窦性心律。

AIM： To investigate the relationship between left atrium （LA） size and atrial fibrillation （AF） and the value of modified left atrial plication in treatment of AF. METHODS ： Two hundred and ten rheumatic heart disease （RHD） patients complicated with AF who accepted valve replacement surgery and refused radiofrequency ablation from January 2008 to January 2012 were reviewed. During valve replacement procedure, 71 patients of the 210 RHD patients （experimental group） underwent modified left atrial plication and the remaining patients （conventional group） chose conventional atrial plication. LAD and AF before and after surgery were examined. RESULTS： LAD after surgery in the experimental group was significantly shorter than in the regular group and the recovery rate of AF in the experimental group was significantly higher than in the conventional group. CONCLUSION： Enlarged LA is closely related to the development of AF and modified left atrial plication may effectively diminish the size and volume of LA in treatment of AF.