风湿性心脏瓣膜病慢性心房颤动左房迷宫术五年随访

评价左房迷宫手术对风湿性心脏瓣膜病慢性心房颤动 (简称房颤 )治疗及心脏功能的远期影响。15例风湿性心脏瓣膜病伴慢性房颤同期施行心脏瓣膜手术和在心外膜标测指导下的左房迷宫手术 ,随访 5 9.2± 7.9个月。结果 :①心脏复跳后心外膜双房标测 11例显示窦性激动 ,4例为心房扑动。②术后 3个月 ,1,3,5年维持窦性心律者分别为 6 7% (10 / 15 ) ,80 % (12 / 15 ) ,86 .6 % (13/ 15 ) ,92 .8% (13/ 14 ) ,且不用任何抗心律失常药。③ 2例因窦性停搏 >3s ,安置永久起搏器。④随访期间左房容积 (76 .0 6± 2 0 .2 3cm3 vs 10 5 .5 1± 33.79cm3 ,P <0 .0 5 )、左房舒张内径(2 .79± 0 .5cmvs 3.6 7± 1.10cm ,P <0 .0 5 )、左室舒张内径 (4 .36± 0 .2 9cmvs4 .6 3± 0 .4 9cm ,P <0 .0 5 )、左室舒张末期容积 (86 .6 1± 14 .5 0cm3 vs 10 3.80± 2 4 .4 8cm3 ,P <0 .0 5 )、心输出量 (4 .6 0± 1.35L/minvs 5 .6 6± 0 .0 5L/min ,P <0 .0 5 )均明显小于术后。随访期射血分数 0 .6 6± 0 .0 7,左室内径短轴缩短率 35 .98%± 5 .39%。左房有收缩功能 87% ,右房有收缩功能 93%。⑤随访期再住院率 2 6 .6 %。结论 :风湿性心脏瓣膜病在换瓣同时进行左房迷宫术能安全有效的消除房颤 ,改善心脏功能和结构。

Left Atrial Maze Procedure for Chronic Atrial Fibrillation Associated With Rheumatic Valve Disease:A Five-Year Follow-up Study

This paper is to assess the long-term outcome of electrophysiologic changes and heart function in patients with chronic atrial fibrillation (AF) associated with rheumatic heart disease who underwent concomitant maze procedure.15 patients underwent left atrial maze procedure combined with valve surgery. Results:In a postoperative follow-up of 59.2±7.9 months,epicardial double atrial mapping after recovery of heart beat showed that 75% of patients had double atrial sinus rhythm and 25% had atrial flutter.67% of all patients (10/15) at during three months after maze procedure, 80% (12/15) at one year, 86.6% (13/15) during two years and 92.8% (13/14) during five years were free of AF without any antiarrhythmic medication. Permanent pac emakers were implanted in 2 patients due to sinus arrest more than 3 seconds.Ech ocardiographic examination showed that left atrial volume( 76.06±20.23 cm 3 vs 105.51±33.79 cm 3 , P<0.05), left atrial dimension( 2.79±0.5 cm vs 3.67±1.10 c m, P<0.05),end-diastolic left ventricular dimension( 4.36±0.29 cm vs 4.63±0.49 cm, P<0.05), and end-diastolic left ventricular volume ( 86.61±14.50 cm 3 vs 103.80±24.48 cm 3,P<0.05) were significantly smaller than those of one month after operation. Cardiac output(4.60±1.35 L/min vs 5.66±0.05 L/min, P<0.05) decreased significantly as compared with that of one month after operation. During the follow-up period,the mean ejection fraction was 0.66±0.07 and the left ventricular fractional shortening was 35.98%±5.39%. Doppler echocardiograms showed that 87% of the patients had documented left atrial function, and 93% of the patients had documented right atrial function. The rehospitalization rate was 26.6%. Conclusion: Left atrial maze procedure combined with valve operation is a safe and effective treatment for eliminating AF associated with rheumatic valve disease and improving heart structure and function.