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改良迷宫手术治疗二尖瓣疾病伴慢性心房颤动 总被引:6,自引:1,他引:5
目的介绍一种治疗二尖瓣疾病伴慢性心房颤动的改良迷宫手术。方法对15例作二尖瓣替换手术的患者同时施行改良迷宫手术,常规建立体外循环及心肌保护。房顶和房间隔联合切口完成后作绕肺静脉口的环形切口。-60℃,2分钟冷冻环形切口左下至二尖瓣后瓣环中点及环形切口左上至左心耳开口之间的区域。连续缝合环形切口,替换二尖瓣。连续缝合左房顶和房间隔,开放主动脉后关闭右心房切口及切除左心耳。结果所有患者术后均康复出院。除二尖瓣替换外尚有5例行左心房血栓清除,3例行三尖瓣环缩。出院随访1~5月(平均3月),15例患者均恢复为窦性心律。结论与maze-Ⅲ手术相比我们所采用的改良迷宫手术技术较为简便,亦安全可行,但其长期效果需进一步观察 相似文献
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心房纤维颤动的外科治疗 总被引:5,自引:2,他引:3
3例采用改良迷宫术探索进行心房纤颤外科治疗获成功。病人术前均为风湿性心脏病,心功能Ⅲ-Ⅳ级,心房纤颤病史3-10年,左房直径52-58mm,心胸比率0.64-0.70。在进行改良迷宫术的同时,2例行二尖瓣替换,1例行双瓣替换及三尖瓣环缩。术后2例自动复跳,1例电击除颤复跳。3例术后早期均为窦性心律。2例术后3年恢复良好,正常心律,心功能I级;1例术后3个月死于脑血管意外。文中重点介绍了手术方法,提 相似文献
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射频消融迷宫术治疗心房纤颤 总被引:3,自引:0,他引:3
作者采用射频消融迷宫术治疗心房纤颤20例,其中19例合并风湿性二尖瓣病的患者,同时行瓣膜替换术,1例合并房间隔缺损患者进行修复。射频消融的路线采用小板井嘉夫的手术径路。术后16例恢复窦性心律,占80%,未恢复窦性心律的4例,2例为房颤,1例为房扑,另1例为结性心律。射频消融迷宫术耗时短,仅增加钳闭主动脉时间平均20.5分钟,无术后出血的潜在危险。但术后7~10天之内,有18例出现过房颤、房扑、房速等室上性心律失常,可能由于射频消融不均匀,干扰心房的心电活动所致。 相似文献
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风湿性心脏瓣膜病房颤的影响因素 总被引:6,自引:0,他引:6
风湿性心脏瓣膜病占我国心血管疾病发病率的50%左右,其中以二尖瓣损害极易影响心房传导系统,造成心房纤颤(房颤)。二尖瓣置换手术患者90%术前存在房颤。二尖瓣置换心脏复跳后,有部分患者可自行恢复窦性心律,并维持稳定的血液动力学。本研究旨在观察心脏瓣膜手术、术前房颤患者术后恢复窦性心律的影响因素。 相似文献
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应用射频迷宫术治疗心房纤颤 总被引:7,自引:4,他引:3
1994年10月于1995年8月采用射频迷宫术先天性继发孔房缺合并心房纤颤1例,瓣膜替换术的治疗风湿性二尖瓣病变合并心房纤颤9例。术后房颤全部消失,呈窦性心律6例,结性心律3例,心房扩动1例。作者认为,此方法操作简单易行,效果确实,手术时间短,避免了心脏多处切口,渗血少,术后平顺,无近期并发症。 相似文献
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目的分析双心房射频消融术与单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动(房颤)的效果。方法回顾性分析2007年1月至2012年12月47例房间隔缺损合并心房颤动接受房间隔缺损修补联合射频消融术治疗患者的临床资料,其中男20例,女27例;年龄35~76岁;房颤病程3个月至15年;持续性房颤18例,长程持续性房颤29例。合并二尖瓣轻度至中度以上关闭不全10例,三尖瓣轻度至中度以上关闭不全28例。根据手术方式不同将47例患者分为两组,单纯右心房消融组(n=19):行房间隔缺损修补术+单纯右心房射频消融术;双心房消融组(n=28):行房间隔缺损修补术+双心房射频消融术。对于二尖瓣、三尖瓣存在轻一中度以上反流者,术中同期行二尖瓣、三尖瓣成形术。所有患者术后3个月、6个月、12个月均接受24h动态心电图检查,1年后间断门诊随访。结果双心房消融组的体外循环时间、主动脉阻断时间及术后住院时间较单纯右心房消融组略长,但两组术后早期并发症及恢复情况无明显差异。心脏复跳时,双心房消融组25例(89.3%)直接恢复窦性心律,3例为交界心律,无房颤心律。单纯右心房消融组14例(73.7%)直接恢复窦性心律,2例为交界心律,3例为房颤心律。出院时,双心房消融组28例(100%)均维持窦性心律;单纯右心房消融组15例(78.9%)维持窦性心律,4例房颤复发(P=0.045)。所有患者均得到随访,随访时间3~75个月,全组无死亡病例;房间隔无残余分流;2例出现二尖瓣轻一中度以上关闭不全,4例出现三尖瓣轻.中度以上关闭不全;双心房消融组术后2年累积窦性心律维持率为87.7%±6.7%,明显高于单纯右心房消融组的47.4%±11.5%(P=0.003)。结论对于成人房间隔缺损合并房颤,双心房射频消融术较单纯右心房射频消融术有更好的治疗效果,而且不会增加手术的风险。 相似文献
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采用改良的迷宫Ⅲ型手术(右侧迷宫术)治疗先天性心脏病合并心房纤颤11例,9例术后即恢复窦必瓦律,1例1周后恢复,1例经口服胺碘胴2周恢复窦性心律;全部病例恢复过程无急性心功能衰竭、心脏压塞和恶性心律失常发生。护理要点:①术前注意观察心率、心律和脉搏变化,指导患者雾化吸入后进行深呼吸和有效咳嗽训练;②术后加强胸部引流管的护理,精确计算出入量,持续心电监护,及时发现心律失常。 相似文献
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The clinical anatomy of the sinus node artery 总被引:5,自引:0,他引:5
BACKGROUND: Our basic aim was to describe the topographic relation between the sinus node artery and the superior posterior border of the interatrial septum with regard to the sinus node dysfunction that follows the superior transseptal approach to the mitral valve. METHODS: During our study 50 human hearts without previous pathologic alterations were analyzed. The position of the sinus node and the course of the sinus node artery were investigated. For identification of the origin of the artery, selective coronary angiograms were performed. The course of sinus node artery and its topographic relation to the interatrial septum was identified by the dry dissections of the hearts. Based on histologic and dry dissected specimens the exact position of the sinus node was determined. RESULTS: We found that the sinus node artery originates from the right coronary artery in 66% of examined cases and from the left coronary artery in 34% of cases. The sinus node artery crosses the superior posterior border of the interatrial septum in 54% of cases. CONCLUSIONS: Our results were compared with clinical studies focusing the incidence of the sinus rhythm disturbance after the superior transseptal approach. The incidence of rhythm disturbance varies from 52% to 60% of cases. Comparing our morphologic and clinical results we can state that the risk for intraoperative damage to the sinus node artery during the superior transseptal approach to the mitral valve is high. 相似文献
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Suzuki R Watanabe T Matsukawa M Hiroshige K Sata S Koyanagi T 《Annals of thoracic and cardiovascular surgery》2011,17(5):514-517
With the use of the superior transseptal approach during mitral valve surgery, good exposure of the mitral valve can be achieved with simple traction sutures, which minimize the risk of deformation of the mitral valve. For this reason, we routinely perform mitral valvoplasty using the superior transseptal approach; however, we, occasionally encounter cases that develop postoperative atrial dysrhythmia. We have therefore, devised a very simple technique for preservation of the sinus node artery in the superior transseptal approach, which is effective for reducing the incidence of postoperative sinus node dysfunction. In this technique, during incision of the dome of the left atrium, the sinus node artery is carefully dissected and preserved. 相似文献
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G M Guiraudon J G Ofiesh R Kaushik 《The Annals of thoracic surgery》1991,52(5):1058-60; discussion 1060-2
Optimal mitral valve operation requires adequate exposure without impairment of atrial physiology, namely sinus node and atrioventricular node function. We used an extended vertical transseptal atrial approach in 34 consecutive patients. The extended vertical transseptal approach combines two semicircular atrial incisions circumscribing the tricuspid and mitral annuli anteriorly and superiorly, allowing exposure of the mitral valve by deflecting the ventricular side using stay sutures. The right atrium is opened anteriorly along the atrioventricular sulcus. The atrial septum is incised vertically through the fossa ovalis. The right atriotomy is extended superiorly in the right coronary fossa between the right atrial appendage and the atrioventricular sulcus to meet the septal incision. The two joint incisions are extended onto the left atrial roof transversely. At this point, the two semicircular incisions are performed and joined, and mitral valve operation is performed. There were 18 women and 16 men. Five patients had ischemic mitral valve regurgitation, 18 had mitral valve prolapse, and 11 had rheumatic heart disease. The mitral valve was replaced in 17 patients and repaired in 17. There were no perioperative complications associated with the atriotomies, ie, no bleeding, no atrioventricular nodal dysfunction, and no sinus node dysfunction. The extended vertical transatrial septal approach provides good mitral valve exposure without inherent complications. 相似文献
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左房顶-房隔径路二尖瓣手术与心律失常 总被引:2,自引:1,他引:2
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。 相似文献
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Kunitomo R Okamoto K Utoh J Nishimura K Muranaka T Tsurusaki S Hagio K Kitamura N 《Kyobu geka. The Japanese journal of thoracic surgery》2001,54(3):211-214
We compared the operative outcomes among 14 patients who underwent the removal of left atrial myxoma with four different approaches; right lateral (n = 2), transseptal bi-atrial (Dubost, n = 4), conventional transseptal (n = 4) and superior transseptal approach (STA, n = 4). Concomitant operations were performed in 4 cases (CABG, two; aortic valvuloplasty, one; mitral valve replacement, one), and two out of 4 cases were in the STA group. The mean operation, cardiopulmonary bypass and aortic cross-clamp times were shorter in the STA group compared to the other three group. The total amount of postoperative drain discharge and the peak value of creatine kinase were also lower in the STA group compared to the other three groups. Among the patients in sinus rhythm before operation, the use of STA was associated with a greater incidence (100%) of postoperative atrial fibrillation or junctional rhythm. These rhythm disturbances were temporary, and all returned to sinus rhythms during hospital stay. We conclude that STA is an excellent approach with a nice surgical view to expose and remove the left atrial myxoma. 相似文献
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Hironori Izutani Masahiro Ryugo Fumiaki Shikata Masashi Kawamura Tatsuhiro Nakata Toru Okamura Takumi Yasugi Mitsugi Nagashima Kanji Kawachi 《Journal of cardiothoracic surgery》2010,5(1):79
A partial lower inverted J sternotomy and an extended transseptal incision provide excellent exposure for minimally invasive
mitral valve surgery. However, the extended trasnsseptal incision causes dividing the sinus node artery, which may result
in conduction system disturbance and need for permanent pacemaker implantation. Therefore, there is a challenge in the patient
who requires concomitant ablation for atrial fibrillation because of possible conduction system disturbance caused by extended
transseptal incision. We describe a new strategy for combined ablation of atrial fibrillation with minimally invasive cardiac
surgery by a transseptal approach to the mitral valve through a partial lower sternotomy incision. Cryoablation was performed
using a T-shaped cryoprobe with a lesion set of pulmonary vein isolation and ablation of the left and right isthmus in performing
mitral annuloplasty, tricuspid annuloplasty, and atrial septal defect closure through a limited sternotomy incision. This
technique might minimize possible conduction system disturbance and provide good surgical result for the patients who undergo
mitral valve surgery and ablation of atrial fibrillation. 相似文献
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Surgical removal of left atrial myxoma through mini sternotomy and the superior transseptal approach
Akira Marumoto Yasushi Ashida Hiroyuki Maeta Shingo Ishiguro Hiroaki Kuroda Shigetsugu Ohgi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2001,49(3):185-187
A 32-year-old man admitted for treatment of a left atrial myxoma showed a 76 x 25 mm tumor in the left atrium originating in the interatrial septum upon echocardiography. The myxoma was surgically removed using a mini sternotomy and the superior transseptal approach. The hospital course was unremarkable. In the 2 years since operation, the patient has remained asymptomatic and tumor-free. The superior transseptal approach is thus useful in surgical removal of left atrial myxoma because it can be excised with minimum manipulation despite the mini sternotomy and small skin incision. 相似文献
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L. Ressia M.D. A.M. Grande M.D. R. Gaeta M.D. G. De Pieri M.D. M. Aiello M.D. M. Viganò M.D. 《Journal of cardiac surgery》1997,12(6):431-433
A bstract Eight patients (4 men, 4 women), mean age 51 years, referred to our Institution for left atrial myxoma underwent removal of the tumor through a superior transseptal approach. All patients in sinus rhythm with normal conduction time. The myxomas were localized in the fossa ovalis (3 cases), interatrial septum (2 cases), left appendage (2 cases), and mitral annulus (1 case). One patient died in hospital after emergency operation for low-output syndrome complicated by septic shock. All other patients had an uneventful postoperative course. Atrial arrhythmias did not represent a major postoperative complication. Transient PR interval elongation was occasionally seen. Electrophysiological studies showed normal sinus node function. At 6 months following operation, patients were evaluated with transeso-phageal echocardiography. There was no tumor recurrence. There were no episodes of arrhythmia in 24-hour electrocardiographic monitoring, and all patients were in NYHA Class I. We believe that the superior transseptal approach gives optimal exposure of the left atrial cavity, overcoming all difficulties related to a small left atrium which is an usual pattern in left atrial myxomas. 相似文献
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O Alfieri L Sandrelli A Pardini C Fucci M Zogno M Ferrari E Caradonna 《European journal of cardio-thoracic surgery》1991,5(6):294-8; discussion 299
The mitral valve was approached through a vertical transeptal incision extended into the roof of the left atrium in 111 patients. Good exposure was invariably provided even in unfavorable situations such as a small left atrium combined with right ventricular hypertrophy or a previously implanted aortic prosthesis. The only hospital death in the entire series was not related to this approach to the mitral valve. Due to breakage of the suture in the roof of the left atrium and to incomplete reconstruction of the atrial septum resulting in a large left-to-right shunt, 2 patients required reinstitution of cardiopulmonary bypass. Both had a smooth postoperative course. Other intra- or postoperative complications related to the incision did not occur. Duration of cardiopulmonary bypass and aortic occlusion was not significantly different from that of patients operated upon through the conventional left atrial approach in the year preceding the experience embraced by this study. Only 3 of 52 patients who were preoperatively in sinus rhythm were discharged in atrial fibrillation. Enhanced atrial vulnerability was demonstrated preoperatively in all 3. These data support a wide application of the extended vertical transeptal approach in mitral valve surgery. 相似文献
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H Tenpaku S Wariishi N Kanemitsu M Okabe T Nakamura 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2000,48(11):688-692
OBJECTIVE: This study was designed to evaluate the safety and effectiveness of the combined superior-transseptal approach for mitral valve surgery. METHODS: We compared the preoperative status, operative factors, and postoperative outcomes among patients having mitral valve operations with three atrial incisions. The incisions were transseptal (n = 40), combined superior-transseptal (n = 33), and left atrial (n = 22). RESULTS: The cardiopulmonary bypass time and cross-clamp time were significantly higher in the superior-transseptal group compared with the transseptal group. No significant difference in blood loss was found among the three groups. The incidence of sinus node dysfunction in the early postoperative period was more common in the superior-transseptal group. The maintenance of sinus rhythm at the mid-term follow-up in patients with preoperative sinus rhythm was not significantly different among the three groups. On the other hand, a few patients in the superior-transseptal and transseptal groups with the preoperative sinus rhythm developed sick sinus syndrome requiring permanent pacemaker implantation. CONCLUSIONS: The use of the combined superior-transseptal approach was safe and effective, and was not associated with a higher incidence of rhythm disturbance. Because this approach provided an optimal exposure of the mitral valve and subvalvular apparatus, it has been positively adopted for use in patients undergoing complex and difficult mitral valve operation. To use this approach for patients undergoing mitral valve surgery through this approach, however, further follow-up study of the sinus node function is necessary. 相似文献