Yuda S, Nakatani S, Kosakai Y, Yamagishi M, Miyatake K
Division of Cardiology, National Cardiovascular Center, Osaka, Japan.
J Am Coll Cardiol. 2001 May;37(6):1622-7. doi: 10.1016/s0735-1097(01)01193-7.
We sought to determine the effectiveness of the maze procedure for maintaining sinus rhythm and atrial contraction for a long period in patients with mitral valve disease.
Although the maze procedure for atrial fibrillation (AF) has been effective in restoring sinus rhythm in patients with mitral valve disease, the long-term results of this procedure have not been determined.
We echocardiographically studied 94 consecutive patients with mitral valve disease before, as well as early (3.1 +/- 3.3 months) and late (2.2 +/- 0.9 years) after, the maze procedure. Peak velocity and the time-velocity integral of the left ventricular (LV) diastolic filling wave during atrial contraction (A wave), as well as the atrial filling fraction (calculated as the ratio of the time-velocity integral of the A wave to total diastolic filling), were obtained from transmitral flow recordings. Peak A wave velocity > or =10 cm/s was considered to indicate echocardiographic evidence of effective atrial contraction.
Regular rhythm with P waves was restored in 70 patients (74%) in the early stage and in 59 patients (63%, p = 0.09) in the late stage after the maze procedure. Forty-seven patients (50%) in the early stage and 36 patients (38%, p = 0.14) in the late stage showed effective atrial contraction by Doppler echocardiography. Left atrial (LA) and LV end-diastolic diameters significantly decreased after the procedure (from 59 +/- 13 to 48 +/- 7 mm, p < 0.01; and from 54 +/- 9 to 47 +/- 5 mm, p < 0.01, respectively) and did not show significant changes during the follow-up period. Once atrial contraction was resumed, its degree did not change between the early and late stages after the maze procedure (17 +/- 6% vs. 17 +/- 6% for atrial filling fraction).
Sinus rhythm and atrial contraction recovered early after the maze procedure in most patients and were maintained for more than two years. Once active atrial contraction was resumed, the degree of contraction did not change thereafter. These results demonstrate that the maze procedure is effective for a long period in patients with mitral valve disease.
我们试图确定迷宫手术在二尖瓣疾病患者中长期维持窦性心律和心房收缩的有效性。
虽然用于治疗心房颤动（AF）的迷宫手术在恢复二尖瓣疾病患者的窦性心律方面有效，但该手术的长期结果尚未确定。
我们对94例连续的二尖瓣疾病患者在迷宫手术前、术后早期（3.1±3.3个月）和晚期（2.2±0.9年）进行了超声心动图研究。从二尖瓣血流记录中获取心房收缩期（A波）左心室（LV）舒张期充盈波的峰值速度和时间-速度积分，以及心房充盈分数（计算为A波时间-速度积分与总舒张期充盈的比值）。A波峰值速度≥10 cm/s被认为表明存在有效心房收缩的超声心动图证据。
迷宫手术后早期，70例患者（74%）恢复了有P波的规则心律，晚期有59例患者（63%，p = 0.09）恢复。早期47例患者（50%）和晚期36例患者（38%，p = 0.14）通过多普勒超声心动图显示有有效心房收缩。手术后左心房（LA）和LV舒张末期直径显著减小（分别从59±13 mm降至48±7 mm，p < 0.01；从54±9 mm降至47±5 mm，p < 0.01），且在随访期间未显示出显著变化。一旦恢复心房收缩，其程度在迷宫手术后早期和晚期之间没有变化（心房充盈分数分别为17±6%和17±6%）。
大多数患者在迷宫手术后早期恢复窦性心律和心房收缩，并维持两年以上。一旦恢复有效的心房收缩，此后收缩程度不再改变。这些结果表明，迷宫手术对二尖瓣疾病患者长期有效。
