右侧迷宫术治疗先天性心脏病合并心房颤动的初步经验  

Initial experience in surgical intervention with right-sided maze procedure for atrial fibrillation in patients with congenital heart disease

作　　者：王志农[1] 汪曾炜[2] 李莉[1] 王尔松[1] 徐志云[1] 张宝仁[1] 郝家骅[1] 

机构地区：[1]第二军医大学长海医院心胸外科,上海200433 [2]沈阳军区总医院心脏外科

出　　处：《中华心律失常学杂志》2006年第1期19-23,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金资助项目(30070749);上海市"医苑新星培养计划"资助项目

摘　　要：目的评价采用右侧迷宫术治疗先天性心脏病合并心房颤动（房颤）的近、远期疗效。方法26例先天性心脏病（21例继发孔型房问隔缺损，5例Ebstein畸形）合并房颤患者，根据心内直视矫正术中有无同期接受右侧迷宫术分成迷宫组（n=15）和对照组（n=11）。房颤病程1～8年，19例为慢性房颤，7例为阵发性房颤。所有患者均有明显的右心房扩大，但均排除二尖瓣病变。结果迷宫组有12例患者于心脏复跳后转为窦性心律，2例术后出现一过性的交界区心律，1例术后仍有间歇性房颤，经口服胺碘酮2周后恢复窦性心律；出院时14例（93．3％）维持窦性心律。对照组有1例患者在心脏复跳后转为窦性心律，另1例应用胺碘酮于术后24h内转为窦性心律，但出院时仅1例维持窦性心律；9例（81．8％）仍维持房颤心律。术后平均随访27．5个月。迷宫组93．3％患者维持窦性心律；对照组81．8％患者维持房颤心律并需口服抗凝药物，其中6例（54．5％）为持续性，包括1例因合并高度房室阻滞安装了永久性心脏起搏器；另2例（18．2％）维持交界区心律；超声心动图检查显示，迷宫组术后1个月三尖瓣和二尖瓣血流频谱呈现E、A双峰；术后1年其左、右心房每搏排出量占心排出量比率分别是术前的（271．44±30．55）％和（363．50±44．22）％，73．3％患者心功能恢复Ⅰ级（NYHA分级），而对照组45．4％心功能恢复Ⅰ级。结论同期施行右侧迷宫术和心内畸形矫正术，能有效地治疗先天性心脏病合并的房颤，并能改善术后左、右心房的传输功能，近、远期疗效较为满意。Objective To evaluate the acute and chronic effects of surgical intervention with rightsided maze procedure for atrial fibrillation （AF） in patients with congenital heart disease. Methods Between Apr. 1998 and May. 2003, there were 26 patients with AF complicating congenital heart diseases （21 with atrial septal defect and 5 with Ebstein＇s anomaly） enrolled in this study. They were divided into maze group （n=15） or control group （n=11）, according to whether having undergone right-sided maze procedure during open heart corrective surgery. Documented AF included chronic AF in 19 and paroxysmal AF in 7, with the duration ranged from 1 year to 8 years. Associated mitral valve disease was excluded. Evaluation was performed before surgery, at discharge and 1, 6, 12 months after surgery. Atrial filling fraction （ventrieular filling related to atrial contraction to total ventricular filling ratio） marked by transtricuspid flow A wave or transmitral flow A wave detected by Doppler echocardiography was used as an index of atrial contraction. Results In maze group, 12 patients recovered to sinus rhythm soon after aortic unclamping and 2 patients developed transient junctional rhythm. One patient was still with paroxysmal atrial fibrillation after the surgery, but converted to sinus rhythm eventually by taking oral amiodarone for 2 weeks. In control group, 2 patients recovered to sinus rhythm after operation including 1 with oral amiodarone. Three patients developed junctional rhythm with 1 converted to sinus rhythm and 2 to AF. However, only 1 patient was with sinus rhythm and 9 were still with AF at discharge. Follow-up was accomplished in all the patients and ranged from 1 year to 5 years （mean 27.5 months）. At the 1-year follow-up evalouation,most patients （93.3%） in maze group were with sinus rhythm. Both right and left atrial filling fraction were significantly improved compared to that before operation （55.5%±80% vs 14.2%±3.4% at the right and 53.1%±6.4% vs 19.9%±4.4% at the left, P

关 键 词：心房颤动 迷宫手术 先天性心脏病 随访 

分 类 号：R541.1[医药卫生—心血管疾病] R654.2[医药卫生—内科学]