瓣膜手术同期行冲洗射频改良迷宫术.docVIP

风心病瓣膜置换术中行射频消融术治疗心房颤动 汤服民 刘聪霞 吴铁军　熊 健　罗运成　王留江 张跃东 李会平 河南省平顶山一五二中心医院心胸外科，467000 摘要　目的　总结冲洗式射频消融迷宫术治疗心房颤动在心脏瓣膜手术中的应用经验。方法　选择2005年6月～2007年12月，我们为39例风湿性心脏瓣膜病合并伴心房颤动患者39例为研究对象，在行心脏瓣膜置换术中，同时，采用心内直视冲洗式射频消融术治疗心房颤动。手术中采用Medtronic CardioblateTM 射频消融装置，参照Cox迷宫Ⅲ手术路径进行心房颤动射频消融术治疗。射频消融功率设为25～28W，生理盐水冲洗速度为5ml/min。先行右心房消融，后行左心房消融。待完成射频消融术后，，射频消融功率设为25～28W，生理盐水冲洗速度为5ml/min。在主动脉阻断前，进行右房射频消融；阻断升主动脉后进行左房射频消融。再按常规行二尖瓣或/和主动脉瓣替换术，在心脏复跳后行三尖瓣成形术。结果　39例患者平均消融时间22±6min；31例自动复跳、8例电除颤后恢复窦性心律，但5例于术后2-5天AF复发，34例成功（占87.2%）。2例发生较严重的并发症，其中1例继发性出血患者再次手术止血痊愈，1例因多器官功能衰竭于术后第6天死亡。随访3～24个月，1例于术后2个月复发。结论　在心脏瓣膜置换同时实施射频消融迷宫术治疗慢性心房颤动是一种简单、安全、有效方法。 关键词：射频消融；改良迷宫术；心房颤动；瓣膜置换术 Saline-irrigated radiofrequency modified maze procedure for atrial fibrillation at heart valve replacement TANG Fu-min,LIU cong-xia, WU Tie-jun, XIONG Jian, LUO Yun-cheng, WANG Liu-jiang, ZHANG Yue-dong, LI Hui-ping. Department of Cardiothoracic Surgery, The 152 Hospital of Jinan Military Region, Pingdingshan, Abstract Objiective To report experience of the saline-irrigated radiofrequency modified maze procedure for atrial fibrillation(AF) during heart valve replacement operation . Methods From June 2005 to December 2007 , 39 patients underwent saline-irrigated radiofrequency modified maze procedure for atrial fibrillation when mitral valves or/and aortic valve operation were performed. Ablation lines were made with Cardioblate (Medtronic ,25-30 W,5 ml/min ). Results One patient died of multiple system organ failure, One patients re-operated for mediastinal hemorrhagein..34 patients converted to normal sinus rhythm (87.2%), 4 patients remained in AF and 1 in node rhythm. In the 3 to 24 month follow-up, 33 patients remained in sinus rhythm (81.8%) and 6 in AF. Conclution The saline-irrigated radiofrequency modified maze procedure is reasonable and efficacious for treating AF at heart Key words: radiofrequency ablation, Modified maze procedure ; Atrial fibrillation; heart valve replacement 2005年6月～2007年12月，我们共对为39例风湿性心脏瓣膜病（简称风心病）