左房顶-房隔径路二尖瓣手术与心律失常

目的：验证左房顶－房隔径路二关瓣手术的安全性。方法：１９９３年１０月至１９９７年１２月，采用此径路行二尖瓣手术５１例，其中二尖瓣替换术（ＭＶＲ）１８例，二尖瓣成形术（ＭＶＰ）１例，二尖瓣及主动脉瓣替换术（ＤＶＲ）３２例。

The experience in mitral valve operation through transseptal - left atrial dome approach and analysis of postoperative cardiac rhythms

Aim:Transseptal-left atrial dome approach provides an excellent field in mitral valve operation.Because it may require division of the sinus node artery in most cases the safety of this approach is controversial.Methods:From October 1993 to December 1997,this approach had been used and its effect on postoperative cardiac rhythms was analyzed for 51 consecutive patients who underwent mitral valve replacement(18 cases),mitral valvuloplasty(1 case) and aortic plus mitral valve replacement(32 cases).Results:All patients were followed up from 2 to 48 moths.There were 2 early deaths postoperatively(3.9%).Among the 12 patients with sinus rhythm preoperatively.2 patients had transient atrial fibrillation and 4 patients had sinus bradycardia postoperatively.Among 37 patients with atrial fibrillation before operation,9 of them recovered to sinus rhythm and persisted permanently during late follow-up.All those with sinus rhythms the sinoatrial node responded normally to exercises.Conclusion:Although the incidence of dysrhythmia was a little high with the transseptal-left atrial dome approach in the early postoperative period,it is reversible.This approach could provide a good access to the mitral valve.