摘要
目的总结射频改良迷宫手术治疗二尖瓣病变合并心房颤动（AF）的临床经验。方法 2003年5月至2008年12月我们对122例合并永久性AF的心瓣膜病患者行二尖瓣置换术,同期施行射频改良迷宫手术,其中男31例,女91例;年龄23-65岁（47±10岁）。AF持续时间0.5-32.0年（6.5±5.7年）,二尖瓣狭窄57例,二尖瓣关闭不全7例,二尖瓣狭窄伴关闭不全58例。采用Cardioblate系统（Medtronic公司,单极射频笔、射频能量25-30 W、盐水冲洗速度180-240 ml/h）,首先完成右心房迷宫手术,阻断升主动脉以冷晶体或含血心脏停搏液灌注保护心肌,经房间沟或房间隔进入,分别环绕左右肺静脉口做消融线,并从左侧环线向二尖瓣后瓣环及左心耳口做消融线,完成连接左右环线之间的消融。处理左心耳及相应的心瓣膜病变。术后常规使用胺碘酮,定期随访。结果术后围术期死亡4例,其中因多器官功能衰竭死亡2例,机械瓣故障死亡1例,猝死1例。随访115例,失访3例;随访时间1.5-7.0年（4.8±2.6年）,随访期间死亡4例,其中猝死3例,机械瓣膜故障1例。87例（78.4%,87/111）患者恢复了窦性心律,22例仍为AF,1例为心房扑动,另1例术后1年需置入永久性起搏器。随访期间（术后0.5-7.0年）患者左心房内径较术前明显缩小（44.90±7.50 mm vs.54.30±10.80 mm,t=10.641,P=0.000）。结论射频改良迷宫手术治疗二尖瓣病变合并AF是相对安全的,但术后心律不稳定、心动过速及AF复发并非罕见,因此对这些患者AF的手术指征应该个体化。
Objective To summarize the experiences of radiofrequency modified maze procedure for atrial fibrillation（AF） in patients with mitral valve diseases.Methods From May 2003 to December 2008,122 patients,including 31 males and 91 females,with permanent AF underwent radiofrequency modified maze procedure as a combined operation with mitral valve replacement.Their age ranged from 23 to 65 years old（47±10 years）.The duration of AF varied from 0.5 to 32.0 years（6.5±5.7 years）.There were 57 cases of stenosis,7 cases of regurgitation and 58 cases of both stenosis and regurgitation.Ablation lines were made with Cardioblate（Medtronic,monopolar,25-30 W,180-240 ml/h）.After right-sided maze procedure was finished,aorta was cross-clamped and cold crystalloid or blood cardioplegia were delivered for myocardial protection.Left atrial incision was performed through the interatrial groove or interatrial septum.The ablation lines were created to encircle the orifices of the left and right pulmonary veins respectively.The ablation lines were also performed from the left encircling line to the posterior mitral valve annulus and to the orifice of left atrial appendage respectively.An ablation line was used to connect the circumferential line of left and right pulmonary veins.The left atrial appendage was tied and concomitant operations were performed.Amiodarone was given to the patients after operation and regular follow-up was done.Results There were four perioperative deaths including 2 cases of multiple organ failure,1 case of mechanic valve obstruction and 1 sudden death.Follow-up was done to 115 patients for 1.5-7.0 years（4.8±2.6 years） with three cases lost.During the follow-up period,four patients died,including 3 sudden deaths and 1 case of prosthetic obstruction.Eighty-seven patients（78.4%,87/111） recovered to sinus rhythm;22 patients still had AF;1 patient had atrial flutter;and 1 patient required a permanent pacemaker one year after the operation.Diameter of left atrium after operation（0.5-7.0 years） was decreased compared with that before operation（44.90±7.50 mm vs.54.30±10.80 mm,t=10.641,P=0.000）. Conclution Radiofrequency modified maze procedure for AF in patients with mitral valve disease is relatively safe.But heart rhythm instability,tachyarrhythmia and recurrent AF are not rare for those patients.Therefore,the surgical indication of AF should be individualized.
出处
《中国胸心血管外科临床杂志》
CAS
2010年第5期381-384,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
射频迷宫手术
心房颤动
二尖瓣置换术
Radiofrequency maze procedure
Atrial fibrillation
Mitral valve replacement
