Sandoval N, Velasco V M, Orjuela H, Caicedo V, Santos H, Rosas F, Carrea J R, Melgarejo I, Morillo C A
Departmento de Cirugia Cardiovascular, Fundación Clínica Shaio, Bogotá, Colombia.
Am J Cardiol. 1996 Mar 15;77(8):591-6. doi: 10.1016/s0002-9149(97)89312-5.
Atrial fibrillation (AF) is generally associated with rheumatic valve disease and atrial septal defects (ASD) in young adults. Surgical correction of both disorders fails to convert to sinus rhythm or prevent further episodes of paroxysmal or chronic AF in most patients. The role and efficacy of combining mitral valve surgery or ASD correction with AF surgery in this setting has not been widely addressed and remains to be established. The present study prospectively assessed the recovery of sinus rhythm, functional status, and atrial function in 21 patients (mean age 42 +/- 9.2 years) who underwent a modified Cox-maze procedure concomitant with mitral valve or ASD surgery at our institution between March 1993 and February 1995. Seventeen (81%) had chronic AF, and 4 (19%) had paroxysmal AF, with a mean AF duration of 3.5 +/- 3.6 years (range 0.6 to 15.3). Concomitant surgery was performed in 9 patients (42.9%) with mitral stenosis, 5 (23.8%) with mitral regurgitation, 1 (4.8%) with mitral and aortic regurgitation, and 3 (14.3%) with ASD. Eighteen patients (86%) were in New York Heart Association class II to IV before operation. Doppler echocardiography was performed in all patients before surgery, and 1 week, and 3 and 6 months after surgery in patients maintaining sinus rhythm. One patient with severe mitral stenosis and depressed ventricular function died in the immediate postoperative period. Sinus rhythm was restored in the immediate postoperative period in 7 patients (35%), and in another 10 patients (50%) before discharge (mean 5.8 +/- 2 days). Overall, sinus rhythm was restored before discharge in 17 patients (85%); 3 (15%) patients required antiarrhythmic therapy. Doppler echocardiography performed 3 months after surgery documented atrial contractility (A and E waves) in 12 patients (71%). After a mean follow-up period of 8 months (range 3 to 23), 18 (90%) remained in sinus rhythm. Sinus rhythm was successfully restored and maintained in most patients with drug refractory AF undergoing a concomitant Cox-maze procedure with mitral valve or ASD surgery improving atrial function and New York Heart Association class.
心房颤动（AF）在年轻成年人中通常与风湿性瓣膜病和房间隔缺损（ASD）相关。对这两种疾病进行手术矫正，在大多数患者中并不能恢复窦性心律或预防阵发性或慢性房颤的进一步发作。在这种情况下，将二尖瓣手术或ASD矫正与房颤手术相结合的作用和疗效尚未得到广泛探讨，仍有待确定。本研究前瞻性评估了1993年3月至1995年2月期间在我们机构接受改良Cox迷宫手术并同时进行二尖瓣或ASD手术的21例患者（平均年龄42±9.2岁）的窦性心律恢复情况、功能状态和心房功能。17例（81%）为慢性房颤，4例（19%）为阵发性房颤，平均房颤持续时间为3.5±3.6年（范围0.6至15.3年）。9例（42.9%）二尖瓣狭窄患者、5例（23.8%）二尖瓣反流患者、1例（4.8%）二尖瓣和主动脉瓣反流患者以及l例（14.3%）ASD患者同时进行了手术。18例（86%）患者术前纽约心脏协会心功能分级为II至IV级。所有患者在手术前、术后1周以及术后维持窦性心律的患者在术后3个月和6个月均进行了多普勒超声心动图检查。1例严重二尖瓣狭窄且心室功能低下的患者在术后早期死亡。7例患者（35%）在术后早期恢复窦性心律，另外10例患者（50%）在出院前恢复窦性心律（平均5.8±2天）。总体而言，17例患者（85%）在出院前恢复窦性心律；3例（15%）患者需要抗心律失常治疗。术后3个月进行的多普勒超声心动图检查显示12例患者（71%）存在心房收缩功能（A波和E波）。平均随访8个月（范围3至8个月）后，18例（90%）患者维持窦性心律。大多数药物难治性房颤患者在接受与二尖瓣或ASD手术同时进行的Cox迷宫手术后，窦性心律得以成功恢复并维持，心房功能和纽约心脏协会心功能分级得到改善。
