瓣膜置换同期改良迷宫射频消融术治疗瓣膜性心脏疾病合并房颤的临床效果评价  

The clinical evaluation of open heart valve replacement combined with modified Maze radiofrequency ablation in the treatment of valvular heart disease with atrial fibrillation

作　　者：郭志祥[1] 张成鑫[1] 葛圣林[1] GUO Zhixiang;ZHANG Chenxin;GE Shenglin(The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学第一附属医院心脏大血管外科,安徽合肥230022

出　　处：《安徽医药》2020年第4期743-746,共4页Anhui Medical and Pharmaceutical Journal

基　　金：安徽医科大学第一附属医院横向课题项目(8224);安徽医科大学校级质量工程项目(3147);安徽医科大学校级质量工程项目(3166);安徽省省级大学生创新创业计划项目(201610366095)。

摘　　要：目的探讨心脏瓣膜置换同期改良迷宫射频消融术治疗瓣膜性心脏疾病合并房颤(atrial fibrillation,AF)的效果。方法2016年1月至2018年12月,安徽医科大学第一附属医院66例心脏瓣膜病合并房颤的病人接受了心脏瓣膜置换联合双极射频消融术。术前心电图确诊房颤心律,超声心动图确诊为心脏瓣膜疾病。比较病人术前及术后心电图、超声心动图资料。结果无围手术期死亡病人。窦性心律术后即时为100%(66/66),出院时为90.9%(60/66),术后六个月时为84.8%(56/66)。术后病人左房内径(45.3±4.8)mm、左室内径(47.3±3.5)mm减小明显(P<0.05),射血分数明显升高(60.8±3.1)(P<0.05),心功能明显改善(45/21)(P<0.05)。结论心脏瓣膜置换同期行改良迷宫射频消融术治疗心脏瓣膜病合并心房颤动安全简便且近期效果满意,值得临床推广。Objective To investigate the impact of combined valve replacement and modified Maze radiofrequency ablation on pa tients with valvular heart disease and atrial fibrillation.Methods FromJanuary 2016 to December 2018,66 patients of valvular heart disease with atrial fibrillation underwent valve replacement combined with modified Maze radiofrequency ablation in The First Affiliated Hospital of Anhui Medical University.Preoperative electrocardiogram confirmed atrial fibrillation and transthoracic echo cardiography showed valvular heart disease.The data of preoperative electrocardiogram and transthoracic echocardiography were compared with the postoperative ones.Results No perioperative death was found.Sixty six(100%)patients maintained sinus rhythm immediately after surgery.Sixty(90.9%)patients maintained sinus rhythm at discharge.With 6 month follow up,fifty six(84.8%)patients maintained sinus rhythm.After surgery left atrial diameter(LAD)and left ventricular end diastolic dimension(LVEDD)of the patients decreased significantly(45.3±4.8mm,47.3±3.5mm,respectively;P<0.05).The ejection fraction(60.8±3.1)and cardiac function of the patients(45/21)were significantly increased(both P<0.05).Conclusion Open heart valve re placement combined with modified Maze radiofrequency ablationhas the advantages of safety,convenience,and affirmative short term effect,which is worthy of clinical promotion.

关 键 词：心脏瓣膜疾病/外科学 心房颤动 导管消融术 心脏瓣膜假体植入 心脏瓣膜成形术 

分 类 号：R654.2[医药卫生—外科学]