瓣膜病合并巨大左心房与房颤的外科治疗  

Surgical treatment of chronic atrial fibrillation and giant left atrium associated with value disease

作　　者：王磊[1] 舒礼良[1] 苏刚[1] 乔洪武[1] 黄明君[1] 徐敬[1] 宋鹏[1] 

机构地区：[1]郑州大学第一附属医院心血管外科,450052

出　　处：《实用医学杂志》2012年第2期215-217,共3页The Journal of Practical Medicine

摘　　要：目的:评估在二尖瓣置换术同期行冲洗式射频消融术和左房折叠术(LAP)治疗巨大左心房慢性房颤(AF)的临床效果。方法:46例收缩末期左心房内径(LAD)≥60mm或左心房容积指数≥55mL/㎡的二尖瓣病变合并慢性AF患者,实施二尖瓣置换术与冲洗式单极射频消融术,其中同期加行左房折叠术(LAP组)23例,未加行LAP术的23例为对照组。应用超声心动图及心电图观察手术前后心功能、左室射血分数(LVEF)、左心房容积指数(LAVI)、心电活动的变化。随访1年。结果:LAP组和对照组恢复并维持窦性心律分别占82.6%和56.5%(P<0.01)、心功能改善级别分别为1.71±0.65和0.78±0.63(P<0.01)、手术后LAVl分别为39.88±11.02和51.86±13.09(P<0.01)、LAEF分别为(64.04±6.81)%和(55.69±5.32)%(P<0.01)。结论:对合并巨大左心房的风湿性二尖瓣病变慢性AF患者,实施二尖瓣置换术和冲洗式射频消融术同期加行左房折叠术,更能有效消除AF,使窦性心律得以恢复和维持,使左心房、心室收缩功能得到进一步的改善,疗效非常明显。Objective To evaluate the benefits of radiofrequency ablation modified maze procedure and left atrial placation （LAP） during mitral valvular replacement in patients with chronic atrial fibrillation and giant left atrium associated with mitral valve disease. Methods Forty-six patients with chronic atrial fibrillation and giant left atrium （left atrial diameter or left atrial volume index over 55 mL/m2）associated with mitral valve disease were treated by radi-ofrequency ablation modified maze procedure and mitral valvular replacement.Among them,23 patients underwent LAP at the same time（LAP group）. The patient＇s changes of heart electricity activity and NYHA were observed by Electrocardiogram, Echocardiogram and the follow-up study was made for 12 months. Results The rate of restoration to sinus rhythm was higher in LAP group than that in the control group （82.6% vs. 56.5% ,P 〈 0.01 ）.The improvement of the NYHA classes was greater in LAP group than that in the control group （1.71 ± 0.65,0.78 ± 0.63,P 〈 0.01）.The Left atrial volume index （LAVI）was smaller in LAP group than that in the control group （39.88 ± 11.02 vs. 51.86 ±13.09,P 〈 0.01）.The left ventricular ejection fraction was higher in LAP group than that in the control group[ （ 64.04 ±6.81）% vs. （55.69±5.32）%,P〈0.01]. Conclusions Forthe patients with chronic atrial fibrillation and giant left atrium associated with mitral valve disease,LAP combined radiofrequency ablation modified maze procedure during mitral valvular replacement is the effective treatment in treating chronic atrial fibrillation, maintaining sinus rhythm and improving atrial and ventricular contraction functions .

关 键 词：射频消融 巨大左心房 慢性颤动 二尖瓣病变 外科手术 

分 类 号：R654.2[医药卫生—外科学] R541.7[医药卫生—临床医学]