Feinberg M S, Waggoner A D, Kater K M, Cox J L, Lindsay B D, Pérez J E
Washington University School of Medicine, Cardiovascular Division, St Louis, MO 63110.
Circulation. 1994 Nov;90(5 Pt 2):II285-92.
The purpose of the present study was to evaluate the effects of the maze procedure on atrial function in patients operated on for atrial fibrillation. The maze procedure is a new surgical intervention that is designed to restore sinus rhythm and active mechanical atrial contraction as a definitive treatment for patients with atrial fibrillation.
Doppler echocardiographic analysis of mitral and tricuspid inflow as well as pulmonary venous flow velocity was carried out in 46 patients 8 +/- 7 months after the maze procedure, and results were compared with those obtained from 27 age-matched control subjects. To evaluate atrial contraction, we determined the presence of atrial contribution to ventricular filling at the mitral and tricuspid valve levels and measured the percent atrial filling fractions of the left and right atria. To evaluate atrial compliance, we measured the systolic and the systolic-to-diastolic flow velocity ratios of the pulmonary venous inflow. Results were compared with similar measurements obtained from control subjects. Restoration of active atrial contraction was detected in 40 of the 46 patients (87%); right atrial contraction was noted in 38 patients (83%), and left atrial contraction was noted in 28 patients (61%). In patients with active atrial contraction, the percent atrial filling fraction of the right atrium was comparable to that of control subjects (32 +/- 7% versus 33 +/- 8%, P = NS), whereas that of the left atrium was smaller (20 +/- 5% versus 36 +/- 7%, P < .005). In addition, compared with control subjects, pulmonary venous flow in maze patients exhibited a reduced systolic component (17 +/- 4 versus 53 +/- 16 cm/s, P < .001) and decreased systolic-to-diastolic flow velocity ratio (0.3 +/- 0.01 versus 1.1 +/- 0.3, P < .001) and velocity integral ratio (0.3 +/- 0.01 versus 1.3 +/- 0.4, P < .001), all suggesting decreased left atrial filling.
The maze procedure restores active right atrial contraction and improves left atrial contraction in most patients. Obtained measurements suggest decreased left atrial compliance and reduced left atrial contribution to ventricular filling compared with control subjects. Despite the reduced indexes, qualitative restoration of function in either atria should translate in improved atrioventricular synchrony and reduction in thromboembolic events in patients with chronic or paroxysmal atrial fibrillation.
本研究的目的是评估迷宫手术对接受房颤手术患者心房功能的影响。迷宫手术是一种新的外科干预措施，旨在恢复窦性心律和活跃的心房机械性收缩，作为房颤患者的确定性治疗方法。
对46例患者在迷宫手术后8±7个月进行二尖瓣和三尖瓣流入以及肺静脉血流速度的多普勒超声心动图分析，并将结果与27例年龄匹配的对照受试者的结果进行比较。为了评估心房收缩，我们确定了二尖瓣和三尖瓣水平下心房对心室充盈的贡献，并测量了左、右心房的心房充盈分数百分比。为了评估心房顺应性，我们测量了肺静脉流入的收缩期和收缩期与舒张期血流速度比值。将结果与从对照受试者获得的类似测量结果进行比较。在46例患者中的40例（87%）检测到活跃的心房收缩恢复；38例患者（83%）出现右心房收缩，28例患者（61%）出现左心房收缩。在有活跃心房收缩的患者中，右心房的心房充盈分数百分比与对照受试者相当（32±7%对33±8%，P=无显著性差异），而左心房的心房充盈分数百分比则较小（20±5%对36±7%，P<.005）。此外，与对照受试者相比，迷宫手术患者的肺静脉血流表现为收缩期成分减少（17±4对53±16cm/s，P<.001）、收缩期与舒张期血流速度比值降低（0.3±0.01对1.1±0.3，P<.001）和速度积分比值降低（0.3±0.01对1.3±0.4，P<.001），所有这些都提示左心房充盈减少。
迷宫手术在大多数患者中恢复了活跃的右心房收缩并改善了左心房收缩。获得的测量结果提示与对照受试者相比，左心房顺应性降低且左心房对心室充盈的贡献减少。尽管指标降低，但任一心房功能的定性恢复都应能改善慢性或阵发性房颤患者的房室同步性并减少血栓栓塞事件。
