风湿性心脏瓣膜置换术同期射频消融迷宫术治疗房颤

目的对合并房颤的心脏瓣膜病患者行瓣膜置换手术的同时进行射频改良迷宫Ⅲ手术,评价风湿性心脏瓣膜置换术同期射频消融迷宫术治疗房颤的临床效果。方法 2010年3月至2011年11月,采用Medtronic公司的射频消融系统对11例合并房颤的心脏瓣膜病患者行瓣膜置换手术的同时进行射频改良迷宫Ⅲ手术,其中包括双瓣置换术1例、二尖瓣置换术10例同时三尖瓣成形术4例。结果术毕转为窦性心律11例,1例窦性心动过缓,1例室速,无Ⅲ°房室传导阻滞,无心房穿孔出血,1例术后低心排死亡,随访3～12个月,10例均为窦性心律,1例术后6个月出现房颤复发,余10例患者超声心动图检查左房明显缩小。结论射频消融改良迷宫Ⅲ手术在治疗合并有房颤的心脏瓣膜病的瓣膜置换手术中安全、简便、易于操作,而且疗效确切,值得推广。

Intraoperative modified maze procedure by radiofrequency ablation to treat atrial fibrillation during concomitant valve replacement of rheumatic heart disease

Objective To analyze the effectiveness of modified maze procedure by radiofrequency ablation in the patients of valvular heart diseases with atrial fibrillation(AF) who underwent heart valve replacement surgery.Methods 11 cases of valvular heart diseases with AF undergoing modified maze procedure by radiofrequency ablation with concomitant Valve Replacement during March 2010 to November 2011 were investigated.Including 1 case of double valvular replacement,10 cases of mitral valvular replacement,four of them with tricuspid valve annuloplasty.Results 11 cases resumed sinus rhythm immediately after the surgery.1 cf them is sinus bradycardia,another case is ventricular tachycardia.Ⅲ°atrial-ventricular block and atrial muscle perforation did not occurr.1 patient occurred death.With 3~12 months follow-up.10 patients remained in sinus rhythm.One patient had atrial fibrillation recurrence after 6 months.And the left atriums of the remaining 10 patients were significantly reduced.Conclusion Valve replace operation combined with radiofrequency modified maze procedure in the treatment of atrial fibrillation with valvular heart disease is safe and worth popularizing.