Shyu K G, Cheng J J, Chen J J, Lin J L, Lin F Y, Tseng Y Z, Kuan P, Lien W P
Department of Emergency Medicine, Shin-Kong Memorial Hospital, Taipei, Taiwan, Republic of China.
J Am Coll Cardiol. 1994 Aug;24(2):392-8. doi: 10.1016/0735-1097(94)90293-3.
We prospectively studied the recovery of atrial function after atrial compartment operation and mitral valve surgery in patients with chronic atrial fibrillation caused by mitral valve disease.
Chronic atrial fibrillation is the most common arrhythmia in mitral valve disease. This arrhythmia is associated with excessive morbidity and mortality. Mitral valve surgery alone rarely eliminates it.
Twenty-two patients underwent mitral valve surgery and a new surgical method, atrial compartment operation. Doppler echocardiography was performed in all patients before operation and at 1 week and 2 and 6 months after operation in the successful cardioversion group. Peak early diastolic (E) and atrial (A) filling velocities, peak A/E velocity ratio and A/E integral ratio of the mitral and tricuspid valves were measured.
Sinus rhythm was restored immediately after operation in 91% of patients and was maintained for > 1 week in 15 (68%) of 22 patients and > 6 months in 14 (64%) of 22. Eleven of 15 patients had left atrial paralysis (A/E integral ratio 0) at 1 week and 6 of 14 patients at 2 months. Nine of 15 patients had right atrial paralysis (A/E integral ratio 0) at 1 week and 1 of 14 patients at 2 months. Both left and right atrial contractile function (presence of an A wave on Doppler findings) was detected at 6 months in 14 patients. Mean (+/- SD) peak atrial filling velocity of the mitral valve was 15 +/- 26 cm/s at 1 week, 38 +/- 39 cm/s at 2 months and 93 +/- 32 cm/s at 6 months (p < 0.001). Mean peak atrial filling velocity of the tricuspid valve was 14 +/- 19 cm/s at 1 week, 33 +/- 19 cm/s at 2 months and 50 +/- 19 cm/s at 6 months (p < 0.001). Peak early diastolic and atrial filling velocities, peak A/E velocity ratio and A/E integral ratio of the mitral and tricuspid valves increased significantly from 1 week to 6 months.
Chronic atrial fibrillation in mitral valve disease can often be eliminated by atrial compartment operation. No surgical mortality or significant complications were encountered. Both left and right atrial function, as manifested by Doppler findings, recover after compartment operation and improve over time. The mechanical function of the right atrium recovers earlier than that of the left.
我们前瞻性地研究了二尖瓣疾病所致慢性心房颤动患者在心房分隔手术和二尖瓣手术后心房功能的恢复情况。
慢性心房颤动是二尖瓣疾病中最常见的心律失常。这种心律失常与较高的发病率和死亡率相关。单独的二尖瓣手术很少能消除它。
22例患者接受了二尖瓣手术及一种新的手术方法——心房分隔手术。在成功复律组的所有患者术前、术后1周、2个月和6个月进行了多普勒超声心动图检查。测量二尖瓣和三尖瓣的舒张早期峰值（E）和心房（A）充盈速度、A/E峰值速度比及A/E积分比。
91%的患者术后立即恢复窦性心律，22例患者中有15例（68%）窦性心律维持超过1周，22例患者中有14例（64%）维持超过6个月。15例患者中有11例在1周时出现左心房麻痹（A/E积分比为0），14例患者中有6例在2个月时出现。15例患者中有9例在1周时出现右心房麻痹（A/E积分比为0），14例患者中有1例在2个月时出现。14例患者在6个月时检测到左、右心房收缩功能（多普勒检查发现有A波）。二尖瓣平均（±标准差）心房充盈峰值速度在1周时为15±26cm/s，2个月时为38±39cm/s，6个月时为93±32cm/s（p<0.001）。三尖瓣平均心房充盈峰值速度在1周时为14±19cm/s，2个月时为33±19cm/s，6个月时为50±19cm/s（p<0.001）。二尖瓣和三尖瓣的舒张早期峰值及心房充盈速度、A/E峰值速度比和A/E积分比从1周到6个月均显著增加。
二尖瓣疾病中的慢性心房颤动常可通过心房分隔手术消除。未遇到手术死亡或严重并发症。心房分隔手术后，多普勒检查显示的左、右心房功能均恢复且随时间改善。右心房的机械功能恢复早于左心房。
