Itoh T, Okamoto H, Nimi T, Morita S, Sawazaki M, Ogawa Y, Asakura T, Yasuura K, Abe T, Murase M
Department of Thoracic Surgery, Yokkaichi Municipal Hospital, Japan.
Ann Thorac Surg. 1995 Aug;60(2):354-9; discussion 359-60. doi: 10.1016/0003-4975(95)00184-m.
This study examined whether the atrial fibrillation that commonly occurs in patients with a mitral valve operation could be eliminated by a concomitant maze operation.
Left atrial function after Cox's maze operation performed concomitantly with a mitral valve operation was evaluated in 10 patients ranging in age from 38 to 67 years (mean age, 54 years). Seven patients who had had coronary artery bypass grafting served as the control group. Using transthoracic echocardiography, the ratio between the peak speed of the early filling wave and that of the atrial contraction wave (A/E ratio) and the atrial filling fraction (AFF) were determined from transmitral flow measurements. These two indices have been considered to represent the contribution of left atrial active contraction to ventricular filling.
The A/E ratio and the AFF were significantly lower in the maze group (0.35 +/- 0.17 versus 0.97 +/- 0.28 [p < 0.01] and 17.6% +/- 8.8% versus 36.8% +/- 6.4% [p < 0.01], respectively). The A/E ratio and the AFF correlated inversely with age (r = -0.72, p < 0.05 and r = 0.76, p < 0.05, respectively) in the maze group. In an angiographic study, the mean left atrial maximal volume index in the maze group was approximately three times larger than that in the control group (117.5 +/- 24.3 mL/m2 versus 35.3 +/- 6.6 mL/m2 [p < 0.01]). The left atrial active emptying volume index was significantly smaller in patients in the maze group (7.2 +/- 2.5 mL/m2 versus 13.1 +/- 4.6 mL/m2 [p < 0.01]).
After the maze procedure performed concomitantly with a mitral valve operation in patients with a dilated left atrium, left atrial contraction is detectable but incomplete in the elderly.
本研究旨在探讨二尖瓣手术患者中常见的心房颤动是否可通过同期迷宫手术消除。
对10例年龄在38至67岁（平均年龄54岁）的患者进行了评估，这些患者在进行二尖瓣手术的同时接受了考克斯迷宫手术。7例接受冠状动脉旁路移植术的患者作为对照组。使用经胸超声心动图，通过二尖瓣血流测量确定早期充盈波峰值速度与心房收缩波峰值速度之比（A/E比值）和心房充盈分数（AFF）。这两个指标被认为代表左心房主动收缩对心室充盈的贡献。
迷宫组的A/E比值和AFF显著更低（分别为0.35±0.17对0.97±0.28 [p<0.01]以及17.6%±8.8%对36.8%±6.4% [p<0.01]）。在迷宫组中，A/E比值和AFF与年龄呈负相关（r = -0.72，p<0.05和r = 0.76，p<0.05）。在一项血管造影研究中，迷宫组的平均左心房最大容积指数约为对照组的三倍（117.5±24.3 mL/m²对35.3±6.6 mL/m² [p<0.01]）。迷宫组患者的左心房主动排空容积指数显著更小（7.2±2.5 mL/m²对13.1±4.6 mL/m² [p<0.01]）。
在左心房扩大的患者中，二尖瓣手术同期进行迷宫手术后，老年人的左心房收缩可检测到但不完整。
