射频消融迷宫术治疗心房纤颤

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。     

改良迷宫手术治疗风湿性心脏病所致心房纤颤

为减少外科治疗风湿性心脏病所致心房纤颤的并发症,对美国Cox设计的心房纤颤迷宫手术进行改良,并应用于临床。1995年9月至1997年9月采用二尖瓣置换加改良迷宫术治疗风湿性心脏病合并心房纤颤4例。本组病人无住院死亡,术后平静稳,无近期并发症。4例病人心脏复跳后均恢复窦性心律,术后3个月窦性心律维持率为100％(4/4),术后半年维持率为75.0％(3/4),术后1年维持率为75.0％(3/4),术后2年维持率为100％(1/1)。作者认为,改良迷宫手术对风湿性心脏病所致心房纤颤效果确实,精简手术操作,有效地防止严重并发症出现。     

心内膜合并心外膜改良迷宫射频消融治疗心房纤颤

目的评价心内膜合并心外膜改良迷宫射频消融治疗心房纤颤的疗效。方法对295例房颤患者进行射频消融,185例进行心内膜加心外膜消融,另110例行心内膜消融。其中男124例,女171例;年龄19—77岁,平均（52±11）岁。90．8％（268／295）患者为风湿性病变。瓣膜手术289例,19例合并冠状动脉旁路移植术。结果手术死亡10例（3．4％）,其中4例死于低心排综合征,5例死于多器官功能衰竭,1例死于脑疝。随访3～47个月,平均（28±5）个月。随访每组各有1例死亡,均死于神经系统并发症。全组术后窦性心律占77．3％（228／295）,其中心内膜组70．9％（78／110）;心内膜加心外膜组81．1％（150／185）（P〈0．05）。最近随访的259例,窦性心律191例,占73．7％,其中心内膜组66．0％（64／97）,心内膜加心外膜组78．4％（127／162）（P〈0．05）。组织学可见心内膜组心肌细胞凝固性坏死灶集中在心内膜侧,近心外膜的坏死灶减少。而心内膜加心外膜组可见病灶分布组织全层,局部有炎症细胞浸润,心肌细胞网状结构破坏消失。结论心内膜合并心外膜射频消融是一种简易、安全、有效的治疗房颤的外科方法,而且效果优于心内膜消融。     

激光心房迷宫术治疗心房纤颤的研究

目的 探讨用Ｎｄ：ＹＡＧ激光照射热凝代替手术切开，行改良的迷宫术Ⅱ治疗心房纤颤。方法 ８条犬右锭端安放起搏电极行心房Ｂｕｒｓｔ刺激，或在静滴氯化乙酰胆碱每分钟１μｇ／ｋｇ体的基础上加用心房Ｂｕｒｓｔ刺激诱发房颤，建立持续性房颤模型后以改良的激光心房迷宫术Ⅲ治疗。术后以同样条件刺激，观察是否还可引出房颤。结果 ８条犬在激光心房迷宫术后以同样条件刺激均不能再诱发出房颤，平均心跳停时间为２４ｍｉｎ。结论     

射频消融迷宫治疗心房纤颤

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得。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。     

改良胸骨上举术治疗漏斗胸的远期疗效

目的 总结改良胸骨上举术治疗漏我的远期疗效。方法 对１９８５年１０至１９９４年１０月期间,收治的１３７例漏斗胸病儿进行了远期随访,随访资料完整者１２１例。包括：胸廓外形、Ｘ线胸片,心肺功能检测。结果 除１例复发外,所有病儿的胸廓外形和漏斗指数都恢复正常,心功能亦恢复下沉但肺功能的恢复比较缓慢。结论 改良胸骨上举术治疗漏我可取得较满意的疗效。     

全胸腔镜改良迷宫手术治疗心房纤颤患者围术期护理

目的总结全胸腔镜改良迷宫术治疗心房纤颤患者围术期护理经验。方法对17例接受全胸腔镜改良迷宫手术的心房纤颤患者的围手术期护理资料进行回顾性分析。结果 17例手术患者中15例成功转为窦性心律,1例患者心房颤动复发,1例起搏心律。术后2例出现呼吸困难,4例引流管口渗液。结论对于全胸腔镜改良迷宫手术治疗心房纤颤患者,全面做好术前评估、心理疏导、术后并发症的观察和护理等措施。可提高手术效果,减少术后并发症的发生。     

改进迷宫手术治疗慢性心房纤颤

目的:为减少外科治疗慢性心房纤颤并发症,对COX迷宫手术进行改进—增加冷冻代替部分手术切口,并应用于临床。方法:采用改进迷宫手术治疗风湿性心脏瓣膜病合并心房纤颤12例,同期行二尖瓣替换术12例,三法瓣环绕6例,左房血栓清除5例。结果:本组无手术死亡。无术后近期并发症。术后12例均恢复窦性心律,术后3个月窦性心律维持率100％(12/12),术后1年窦性心律维持率91％(11/12)。结论:改进迷宫手术治疗慢性心房纤颤手术效果确切,可有效防止并发症并简化手术操作。     

右侧迷宫术治疗先天性心脏病合并心房纤颤的护理

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。     

改良迷宫手术治疗二尖瓣病变伴慢性心房颤动的疗效

迷宫手术〔1〕的技术复杂、心脏停搏时间较长 ,为此 ,一些学者对其进行了改进〔2 -5〕。 1998年 3月我们也采用改良迷宫手术 (ｍｏｄｉｆｉｅｄｍａｚｅｐｒｏｃｅｄｕｒｅ)治疗二尖瓣病变伴慢性心房颤动 (房颤 )的病人 ,现报道如下。资料和方法　 2 2例病人中男 5例 ,女 17例 ;平均 (39 7±10 9)岁。房颤平均持续 (8 8± 6 7)年。其中二尖瓣狭窄 10例 ,二尖瓣关闭不全 8例 ,二尖瓣狭窄伴关闭不全 4例。左房径 (6 0 8± 16 7)ｍｍ ,射血分数 0 5 3± 0 12 ,缩短分数 0 2 8±0 0 7。常规建立体外循环 ,冷晶体心停跳液保护心肌 ,血流…     

Radiofrequency modified maze procedure for chronic atrial fibrillation

Background We studied the effectiveness of Radiofrequency (RF) modified maze in early and late restoration of sinus rhythm in patients with rheumatic heart disease (RHD). Methods We studied 84 patients with RHD over 23.6±12.5 months after the RF modified maze and another group of 64 patients over six months after valvular surgery alone (the Non-Maze group). Any thromboembolic episodes and NYHA class of the patient were recorded. The short term survivors in sinus rhythm, underwent stress test and echocardiography for atrial transport function at 3–6 months after surgery. Results In the Maze group, sinus rhythm was restored in 60/70 patients (85.71%) immediately and sustained in 55/70 patients (78.57%) over the follow-up as against an immediate conversion rate of 5.3% (5/53 patients, p<0.001) in the Non-maze group. The additional Cardiopulmonary (CP) bypass time (p=0.13) and cross clamp time (p=0.511) needed for maze is not statistically significant. Left atrial (LA) transport function was preserved in 41/51 patients (80.4%) and Right atrial (RA) transport function in 51/51 patients (100%). Stress test showed good chronotropic response in all the 41 patients in whom it was performed. In the Maze group one patient presented with acute valve thrombosis and subsequently, succumbed to it. In the non maze group 3/55 patients (5.66%) were hospitalized for stroke. No patient needed permanent pacemaker nor was sinus node dysfunction seen. The immediate postoperative morbidity and mortality was comparable in the two groups. Conclusions The RF modified maze is safe, effective and brief without any additional risk. It restores sinus rhythm in the majority, however there is an attrition in some.     

A modified maze procedure performed only on the left atrium for chronic atrial fibrillation associated with mitral valve disease: Report of a case

We describe herein the successful treatment of a patient with chronic atrial fibrillation (AF) associated with mitral valve stenosis and regurgitation, achieved by performing a modified maze procedure on the left atrium alone. The patient was a 51-year-old man who had suffered from intractable AF for 17 years, causing multiple cerebral emboli and palpitations. He had undergone open mitral commissurotomy and balloon commissurotomy 15 and 7 years ago, respectively. On admission, an echocardiogram revealed mitral valve restenosis and thrombosis in the left atrial appendage. Prosthetic valvular replacement was performed following isolation of all pulmonary veins with cryoablation to the posterior wall of the left atrium and excision of the left atrial appendage. Postoperatively, the AF disappeared and echocardiogram demonstrated a left atrial kick in the mitral valvular inflow without any evidence of thrombosis in the left atrium. Thus, we believe that our modified left side only maze procedure is a simple and efficient method for the treatment of chronic AF with mitral valve disease.     

改良线路心房直视迷宫式射频消融治疗心房颤动

目的：探讨风湿性心脏病合并心房颤动（房颤）病人,在瓣膜置换同时采用改良线路经心房直视迷品式射频消融治疗房颤的可行性及疗效。方法：66例风湿性心脏病二尖瓣病变合并房颤病人,在体外循环心内直视下经心房行迷宫式射频消融,同时行二尖瓣置换术,结果：无手术死亡,57例房颤消失,其中术后窦性心律54例（81．8％）,结性心律1例（1．5％）,心房扑动2例（3％）,9例（13．6％）仍为房颤,随访2－60个月,总随访率89．6％,窦性心律稳定,无远期死亡,结论：经心房内视改良线路迷宫式射频消融治疗房颤,方法简捷,安全有效,远期疗效稳定,值得进一步研究,推广。     

Electrocautery maze in chronic atrial fibrillation: An early experience

Introduction The maze procedure is the only surgical treatment that can alleviate the three physiologic sequelae of atrial fibrillation i.e. tachycardia, thromboembolic events and hemodynamic compromise. In the present study, we attempted ablation of atrial fibrillation (AF) using monopolar conventional cautery. Objective is to demonstrate efficacy of electroxcautery maze in chronic AF in patients undergoing mitral valve surgery and long term efficacy of it in maintaining sinus rhythm. Methods In this series 25 patients who underwent electrocautery maze since 2002 were studied, the age ranged from 20–60 years, 60% of patients were females. 20 patients were in NYHA class IV and 5 patients were in class III, who had left atrium (LA) ranging from 5–6.5 cms with LA appendage clot in 8 patients. All patients underwent mitral valve replacement, 3 patients under went tricuspid valve repair and 2 underwent aortic valve replacement as concomitant procedures. The electrocautery maze was done encircling left & right pulmonary veins along with interconnecting portion. Left atrial appendage was ligated only in cases with LA clot. Results The hospital mortality rate was nil in this group of patients. Freedom from atrial fibrillation or atrial flutter was 92% at 6mths followup. Patients were followed up with regular electrocardiography. Conclusion Electrocautery maze procedure, an adjunctive procedure is safe, time sparing & effective in eliminating atrial fibrillation & restoring atrial transport function. Presented at the 50^th Annual Meeting of IACTS, New Delhi, Feb., 2004.     

Experience with unipolar radiofrequency ablation for atrial fibrillation

BACKGROUND: The cut and sew Cox maze procedure for atrial fibrillation (AF), although effective, is not widely used because of technical complexity, prolonged duration and significant risk of postoperative bleeding. This study reviews our experience with the unipolar radiofrequency ablation (RFA) procedure, which was used to create a modified maze to treat AF. METHODS: A retrospective review of 31 patients undergoing consecutive cardiac surgery who had concomitant RFA for AF over a 16-month period was carried out. A Cobra unipolar RFA probe (EPT; Boston Scientific, San Jose, CA, USA) was used to create a standard set of lesions. RESULTS: There were 20 men and 11 women (mean age, 66 +/- 9 years; range, 48-87 years). AF was continuous in 21 patients and intermittent in 10. The median duration of AF leading up to surgery was 48 months (range, 6 months-20 years). Left atrium was enlarged in 81% of the patients. Operations included mitral valve repair (7 patients), replacement (5), coronary artery bypass (10), aortic valve replacement (1) and combined procedures (8). There were no complications directly attributable to RFA. There were three early deaths. One patient required a permanent pacemaker. Median follow up was 22 months (range, 12-30 months). One patient died 2 years after the operation from a stroke. Cardioversion was attempted in five patients within 3 months of operation and was successful in four. At 2 years following the procedure, the probability of the patient remaining in sinus rhythm was 0.71 +/- 0.15. CONCLUSION: Surgical RFA can be carried out as a useful adjunct to conventional cardiac surgery. Although the results were satisfactory in this series, further studies are needed to refine the indication of the procedure and to assess its longer-term efficacy.     

改良迷宫手术治疗二尖瓣疾病伴慢性心房颤动

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     

Long-term results following concomitant radiofrequency modified maze ablation for atrial fibrillation

Abstract Background and aim of study: This study evaluated the long‐term outcome of linear, endocardial, radiofrequency (RF) atrial ablation for the treatment of atrial fibrillation (AF) concomitantly to open‐heart procedures for acquired cardiac organic disease. Methods: A saline‐irrigated “pen‐like” RF ablation catheter (Cardioblate^®, Medtronic, Minneapolis, MN, USA) was used to perform endocardial lines of conduction block in 293 patients with AF who underwent open‐heart procedures between September 2000 and February 2008. Results: Patients (age of 65 ± 11 years) underwent left atrial ablation for permanent (44%), paroxysmal (51%), or undetermined (4.4%) AF. Maintenance in sinus rhythm (SR) at discharge and at the end of follow‐up (average 3.3 ± 1.2 years) was observed in 52% and 71% of patients, respectively. Preoperative type or duration of AF did not influence the results (p = NS). Multivariate analysis with a logistic regression model showed left atrial diameter and increasing age were independent predictors of recurrent AF. In this study, return to SR did not influence survival. Conclusions: This study confirmed that concomitant intraoperative RF ablation is an effective technique to restore long‐term SR after cardiac surgery in patients with preoperative AF but does not influence long‐term survival. (J Card Surg 2010;25:608‐613)