Bernstein N E, Skipitaris N T, Glotzer T V, Delianides J, Chinitz L A, Colvin S
Department of Cardiac Electrophysiology, New York University Medical Center, New York 10016, USA.
Pacing Clin Electrophysiol. 1996 Nov;19(11 Pt 2):1944-6. doi: 10.1111/j.1540-8159.1996.tb03258.x.
The biatrial approach to exposing the mitral valve during surgery has the potential for improving visualization of the valve with minimal cardiac manipulation. This procedure, involving a right atriotomy and an extended transseptal incision, may isolate the sinus node from its normal blood supply and autonomic innervation. Thirty-eight consecutive patients undergoing this procedure were examined. Twenty-two of these patients (58%) were admitted in normal sinus rhythm and 15 (40%) were in atrial fibrillation (AF) or atrial flutter. Of the 22 patients admitted in normal sinus rhythm, only 3 patients remained in this rhythm at discharge. Fourteen of the 22 patients were discharged in a slow, low atrial rhythm. All of the patients admitted in AF were discharged in AF. Of the 14 patients discharged in a low atrial rhythm, the rhythm persisted in eleven patients (80%) at a mean of 6-month follow-up. The routine use of this transseptal approach to mitral valve surgery needs further assessment in light of the predictable loss of the sinus mechanism.
手术中采用双心房入路暴露二尖瓣，有可能在对心脏操作最少的情况下改善瓣膜的可视化。该手术包括右心房切开术和延长的经房间隔切口，可能会使窦房结与其正常血供和自主神经支配分离。对连续38例接受该手术的患者进行了检查。其中22例患者（58%）入院时为正常窦性心律，15例（40%）为心房颤动（AF）或心房扑动。在22例入院时为正常窦性心律的患者中，出院时仅有3例仍为此心律。22例患者中有14例出院时为缓慢的低位心房节律。所有入院时为AF的患者出院时仍为AF。在14例出院时为低位心房节律的患者中，平均随访6个月时，11例患者（80%）仍维持该节律。鉴于窦房结机制可预测的丧失，二尖瓣手术常规使用这种经房间隔入路需要进一步评估。
