Gregori F, Cordeiro C O, Couto W J, da Silva S S, de Aquino W K, Nechar A
Department of Surgery, State University of Londrina Medical School, Paraná, Brazil.
Ann Thorac Surg. 1995 Aug;60(2):361-3; discussion 364. doi: 10.1016/0003-4975(95)00314-b.
From August 1993 to May 1994, 20 patients (mean age, 43 years) with atrial fibrillation underwent the maze operation without cryoablation. Ten patients had mitral stenosis, 5 had mitral insufficiency, and 5 had a mixed mitral lesion. The mean left atrial diameter as measured on echocardiograms was 6.1 cm. The cause was rheumatic in 17 patients (85%) and degenerative in 3 (15%). Seven patients had had previous episodes of thromboembolism.
Mitral valvuloplasty was performed on 7 patients, mitral commissurotomy on 4, and mitral valve replacement on 9. Thrombi were found in the left atrium of 7 patients and also in the right atrium in 2. The mean cross-clamp time was 73 minutes (range, 52 to 108 minutes).
Patients were discharged from the hospital in good condition. Hemodynamic studies and Doppler echocardiograms showed significant reduction in the left atrial diameter (mean diameter, 4.9 cm; p < 0.01) in 18 patients. The two-channel Holter monitor showed sinus rhythm in 15 patients, atrial ectopic rhythm in 4, and atrial fibrillation in 1. Eleven patients (55%) experienced atrial fibrillation (9 in the first 3 months postoperatively), which was reversed with quinidine. Ninety percent of patients had development of an effective, synchronous, atrial systole. Six to 15 months postoperatively (average follow-up, 10 months), all patients were in functional class I, and 18 were not on a regimen of antiarrhythmic medication.
This simplification of the maze operation has been demonstrated to be an effective alternative for the treatment of chronic atrial fibrillation.
1993年8月至1994年5月，20例心房颤动患者（平均年龄43岁）接受了未行冷冻消融的迷宫手术。10例患者有二尖瓣狭窄，5例有二尖瓣关闭不全，5例有二尖瓣混合病变。超声心动图测量的平均左心房直径为6.1cm。病因在17例患者（85%）中为风湿性，3例（15%）为退行性。7例患者既往有血栓栓塞发作。
7例患者行二尖瓣成形术，4例患者行二尖瓣交界切开术，9例患者行二尖瓣置换术。7例患者左心房发现血栓，2例患者右心房也发现血栓。平均阻断时间为73分钟（范围52至108分钟）。
患者出院时情况良好。血流动力学研究和多普勒超声心动图显示18例患者左心房直径显著减小（平均直径4.9cm；p<0.01）。双通道动态心电图监测显示15例患者为窦性心律，4例患者为房性异位心律，1例患者为心房颤动。11例患者（55%）发生心房颤动（9例在术后前3个月），用奎尼丁逆转。90%的患者出现有效、同步的心房收缩。术后6至15个月（平均随访10个月），所有患者心功能均为Ⅰ级，18例患者未服用抗心律失常药物。
迷宫手术的这种简化已被证明是治疗慢性心房颤动的一种有效替代方法。
