Sueda T, Shikata H, Orihashi K, Mitsui N, Sueshiro M, Matsuura Y
First Department of Surgery, Hiroshima University, School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Nov;42(11):2117-21.
A 45-year-old female of mitral valvular disease with chronic atrial fibrillation was referred to our hospital. She had received previous closed mitral commissurotomy (12 years ago) and open mitral commissurotomy combined with aortic valve replacement (6 years ago). An echocardiogram showed restenosis and regurgitation of the mitral valve (valve area 1.2 cm2 by B-mode) and severe regurgitation of the tricuspid valve. She also complained of chronic atrial fibrillation since 35 years old. Mitral valve replacement with CarboMedics bileaflet valve (25 mm) and tricuspid annuloplasty by DeVega procedure was undergone via an extended transseptal approach and cryoablastion was added to the posterior wall of the left atrium along the rim of the left pulmonary veins and around the left atrial appendage for ablation of chronic atrial fibrillation. After completion of surgery, atrial fibrillation disappeared. Post operative echocardiogram showed apparent atrial kick of both atriumns in the inflow pattern of both ventricles. The patient continues to be well with normal sinus rhythm for 6 months after surgery. An extended transseptal approach is useful in mitral reoperation, in addition, it can be applicable for the surgery of chronic atrial fibrillation.
一名45岁患有二尖瓣疾病并伴有慢性心房颤动的女性被转诊至我院。她曾接受过闭式二尖瓣交界切开术（12年前）以及二尖瓣交界切开术联合主动脉瓣置换术（6年前）。超声心动图显示二尖瓣再狭窄及反流（B型超声测得瓣口面积为1.2平方厘米）以及三尖瓣重度反流。她自35岁起就一直抱怨患有慢性心房颤动。通过扩大经房间隔入路进行了CarboMedics双叶瓣（25毫米）二尖瓣置换术及DeVega法三尖瓣环成形术，并沿左肺静脉边缘及左心耳周围在左心房后壁添加冷冻消融术以治疗慢性心房颤动。手术完成后，心房颤动消失。术后超声心动图显示在两个心室的流入模式中两个心房均有明显的心房收缩。术后6个月患者窦性心律正常，情况良好。扩大经房间隔入路在二尖瓣再次手术中很有用，此外，它还可应用于慢性心房颤动的手术。
