Lima Gustavo G, Kalil Renato A K, Leiria Tiago L L, Vanni Gustavo F, Miglioransa Marcelo H, Faria-Corrêa Daniel L, Hatem Domingos, Abrahão Rogério, Sant'Anna João R, Prates Paulo, Nesralla Ivo A
Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil.
Arq Bras Cardiol. 2004 Apr;82(4):337-45. doi: 10.1590/s0066-782x2004000400005.
To assess the efficacy of surgical isolation of the pulmonary veins for re-establishing sinus rhythm in patients with atrial fibrillation secondary to mitral valve disease.
Thirty-three (67% were women) patients with permanent atrial fibrillation and indication for surgical correction of the mitral valve underwent surgical isolation of the pulmonary veins. Their mean age was 56.3+/-10 years, preoperative NYHA functional class was 3.2+/-0.6, left atrial size was 5.5+/-0.9 cm, and ejection fraction was 61.3+/-13%. The surgical technique consisted of a circumferential incision surrounding the 4 pulmonary veins, excision of the left atrial appendage, and a perpendicular incision originating in the inferior margin of the circumferential incision isolating the pulmonary veins down to the mitral valve. Early arrhythmias were aggressively treated with cardioversion.
The mean follow-up was 23.9+/-17 months, and 3 patients died in the postoperative period. Ten patients required electrical cardioversion in the postoperative period; 87% had sinus rhythm in the last medical visit, and 33% were using amiodarone.
Isolation of the pulmonary veins associated with mitral valve surgery is an effective and safe technique for maintaining sinus rhythm in patients with permanent atrial fibrillation.
评估肺静脉手术隔离术对二尖瓣疾病继发心房颤动患者恢复窦性心律的疗效。
33例（67%为女性）永久性心房颤动且有二尖瓣手术矫正指征的患者接受了肺静脉手术隔离术。他们的平均年龄为56.3±10岁，术前纽约心脏协会（NYHA）心功能分级为3.2±0.6级，左心房大小为5.5±0.9厘米，射血分数为61.3±13%。手术技术包括围绕4条肺静脉做环形切口、切除左心耳以及从环形切口下缘起始向下至二尖瓣做垂直切口。早期心律失常采用电复律积极治疗。
平均随访时间为23.9±17个月，3例患者在术后死亡。10例患者在术后需要进行电复律；在最后一次就诊时，87%的患者恢复了窦性心律，33%的患者正在使用胺碘酮。
对于永久性心房颤动患者，肺静脉隔离联合二尖瓣手术是维持窦性心律的一种有效且安全的技术。
