Clinical Research on Left Atrial Reduction and Modified Maze in the Treatment of Chronic Atrial Fibrillation in Rheumatic Heart Disease
|Keywords||Left atrial volume reduction surgery Modified maze procedure Atrial fibrillation Rheumatic heart disease Brain natriuretic peptide|
Objective To evaluate left atrial volume reduction surgery (left atrial reduction, LAR) and modified maze procedure for the treatment of rheumatic heart disease (RHD ) associated with chronic atrial fibrillation (CAF) , the clinical effect . Methods 60 patients with left atrial volume index ≥ 55mL/m2 of rheumatic heart disease with CAF patients , the implementation of the mitral valve replacement with modified maze procedure , modified maze procedure improved III maze procedure based , which over the same period plus row left atrial volume reduction surgery (LAR ) , 30 cases , LAR surgery not add lines 30 cases of the control group . Application electrocardiogram and echocardiography in cardiac electrical activity of the two groups of patients before and after surgery , NYHA left atrium inside diameter ( LAD ) , left atrial volume index ( LAVI ) , left ventricular ejection fraction (LVEF), cardiothoracic ratio (C / T) and dynamic changes of plasma brain natriuretic peptide (BNP) . The follow-up period of 1 year. Results LAR group and a control group to restore and maintain sinus rhythm , respectively, 76.6% and 50 % ( P lt; 0.01 ) , improvement of cardiac function levels were 2.0 ± 0.6 and 1.1 ± 0.5 (P lt; 0.01), postoperative LAD 40 ± 0.8mm mm and 59 ± 1.2mm ( P lt; 0.05 ) , LAVI 52.45 ± 8.35 ml/m2 and 66.45 ± 12.42 ml/m2 ( P lt; 0.05 ) , LVEF were 0.66 ± 0.08 and 0.56 ± 0.12 (P lt; 0. 05), C / T were 0.56 ± 0.10 and 0.64 ± 0.11 ( P lt; 0.05 ) . 6 months after plasma BNP was 170.35 ± 62.15 and 628.57 ± 212.35 (P lt ; 0.05 ) . Conclusion CAF in patients with rheumatic heart disease with giant left atrium and left atrial volume reduction surgery a heart valve replacement surgery and modified maze procedure for the same period plus line , the ratio can improve the cure rate and long-term maintenance of AF to sinus rhythm ; while the left atrium active contractile function room further improvement , and can significantly reduce postoperative plasma brain natriuretic peptide levels .