摘要
目的报告二尖瓣置换时采用盐水冲洗的射频改良迷宫手术治疗心房颤动。方法2003年5月至2006年4月83例二尖瓣置换手术患者接受了术中盐水冲洗的射频改良迷宫手术,本组患者中男性23例、女性60例,年龄23～65(46±12)岁,二尖瓣狭窄49例、二尖瓣反流6例、二尖瓣双病变28例,心功能(NYHA分级)Ⅳ级7例、Ⅲ级76例,心房颤动持续时间0．5-18．0(5．4±4．0)年。手术采用Cardioblate系统,射频能量25～30 W,盐水冲洗速度180～240 ml／h。在完成右心房主要的切口及消融后阻断主动脉,经房间隔后左心房切口或房间隔切口施行左心房消融、二尖瓣置换及其他所需的手术,复跳后再完成右心房余下的消融及切口。术后常规使用胺碘酮,定期随访。结果术后围术期死亡2例(机械瓣故障1例,多器官衰竭1例)。体外循环时间70～160(101±26)min,主动脉阻断时间32～106(61±22)min,射频消融时间4～23(11±6)min。随访过程中猝死2例,失访2例。62例患者术后随访1年以上,其中53例恢复窦性心律(85％,53／62)。结论二尖瓣置换时采用盐水冲洗的射频改良迷宫手术治疗持续心房颤动是合理及有效的。
Objective The saline-irrigated radiofrequency modified maze procedure was applied tor atrial fibrillation during mitral valve replacement operation. Methods From May 2003 to April 2006, eightythree （ men 23, women 60） patients underwent saline-irrigated radiofrequency modified maze procedure for atrial fibrillation during mitral valve replacement. Their age ranged from 23 -65 （46±12 ） years. The duration of atrial fibrillation varied from 0. 5 - 18.0 （5.4±4. 0） years. The mitral lesion were 49 stenosis, 6 regurgitation and 28 mixed. Ablation lines were made with Cardioblate （ Medtronic, 25 - 30W, 180 - 240 ml/h）. The ablation lines were created to encircling the orifices of the left and right pulmonary veins, respectively. An ablation line was used to connect left and right pulmonary veins circumferential line. The left appendage was amputated and the left atrium was closed. Results Two patients died post perioperative period due to acute mechan- ic valve obstruction or multiple organ failure. CPB time varied from 70 - 160（ 101±26） min, and cross-clamping time varied from 32 - 106（61±22） min. The ablation time varied from 4 -23（ 11 ±6） min. Concomitant surgical procedures included： aortic valve replacement 10 cases, tricuspid annuloplasty 24 cases, removing the left atrial thrombi 10 cases. At follow-up two patients suffered from sudden death and two cases lost. During follow-up over 1 year 85% patients （53/62） were free of atiral fibrillation. Conclusion The saline-irrigated radiofrequency modified maze procedure is reasonable and efficacious for permanent atrial fibrillation at mitral valve replacement.
出处
《中华心律失常学杂志》
2006年第5期342-344,共3页
Chinese Journal of Cardiac Arrhythmias
基金
四川省科技攻关课题(05SG022-014)
关键词
改良迷宫手术
心房颤动
二尖瓣置换
Modified maze procedure
Atrial fibrillation
Mitral valve replacement
