摘要
目的 回顾性分析二尖瓣置换术 (MVR)同期Cox迷宫III型手术治疗风湿性二尖瓣病变伴房颤 (Af)的效果。方法 1994年 3月至 1999年 2月间采用上述方法治疗病人 5 4例。其中男 30例 ,女2 4例 ;年龄 (45 32± 6 37)岁。风湿病史 15年以上 ,房颤病史 2～ 7年。术前心功能III～IV级。均行MVR +Cox迷宫III型手术 ,三尖瓣中度以上关闭不全者附加三尖瓣成形术 (TVP) 34例 ,清除左房血栓 4例。结果 本组无手术死亡 ,主动脉阻断和体外循环时间分别为 (75± 2 0 )min和 (12 4± 36 )min。复跳后出血 2例 ,止血治疗均有效。随访 2 4～ 5 0个月 ,术后Af均消失。有 1例为结性心律 ;窦性心律者占98 11% (5 2 / 5 3例 ) ,最大体力活动时均无窦性迟钝现象 ,无需安装起搏器 ,均有心房收缩功能 ;术后 1年心功能Ⅰ级者占 98 11% (5 2 / 5 3例 ) ,II级 1 88% (1/ 5 3例 ) ;无抗凝严重出血 ,亦无血栓栓塞并发症。术后早期死亡 1例 (1 85 % ) ,术后 1周死于多脏器功能衰竭。术后第 3年晚期死亡 1例 (1 88% )。结论 MVR同期行迷宫III型手术治疗风湿性二尖瓣病变伴房颤安全有效 ,能消除Af,恢复心房收缩功能 ,可避免术后血栓栓塞并发症 ,远期疗效确切。
Objective: To analyze retrospectively the effect of the Cox/maze III procedure for the surgical treatment of atrial fibrillation associated with rheumatic mitral valve disease. Methods: From March 1994 to February 1999, the Cox/maze III procedure plus mitral valve replacement (MVR) was performed in 54 patients [male 30, female 24, age (45 32±6 37)years] with atrial fibrillation associated with rheumatic mitral valve disease. The history of rheumatism was more than 15 years, and duration of preoperative Af was 2～7 years, preoperative NYHA class III～IV. Cox/maze III procedure and MVR were performed in all patients accompanied with TVP in 34 patients and extraction of left atrial thrombus in four patients. Results: Duration of aortic cross clamp time and CPB time was (75±20) min and (124±36) min, respectively. Bleeding was stopped in two patients after the heart restored beating. All patients were followed up 24 to 50 months; Af disappeared in all patients. Normal sinus rhythm was restored in 98.11%(52/53), but one with having node rhythm. No blunted sinus node response to maximal exercise and no pacemaker implantation are needed. Atrial contractility was restored in all the patients with sinus rhythm. One year after operation, 98.11%(52/53) of patients' cardiac function was improved to class I and 1.88%(1/53) class II. No thromboembolism and serious hemorrhage related to anticoagulant therapy have happened. The early mortality was 1 85%(1/54). The cause of death was MOF was one week postoperatively. The late mortality was 1 88%(1/53). Conclusion: The addition of Cox/maze III procedure to MVR is safe and effective for selected patients, resulting in elimination of Af, decreased thromboembolism complication, restoration of atrial contractility and an excellent long term result.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2002年第5期264-266,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
