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J Thorac Cardiovasc Surg 1998;116:220-224
© 1998 Mosby, Inc.
Surgery for Adult Cardiovascular Disease |
From the Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Received for publication June 27, 1997. Revisions requested Oct. 20, 1997; revisions received March 4, 1998. Accepted for publication March 5, 1998. Address for reprints: Fumitaka Isobe, MD, Department of Cardiovascular Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan.
Objective: The efficacy of the Cox maze III procedure for chronic atrial fibrillation associated with mitral valve disease is unclear, and so was evaluated in this study.
Methods: In 30 patients, we applied the maze III procedure (cut and suture), except for one modification in the case of a left posterior sinus node artery. After dividing the patients into sinus rhythm and atrial fibrillation groups more than 6 months after the operation, we compared various parameters.
Results: Sinus rhythm was restored in 27 patients (90%). One patient had atrioventricular reentrant tachycardia and needed a pacemaker for sick sinus syndrome (3.3%). The f-wave voltage in lead V1, the preoperative cardiothoracic ratio, the preoperative left atrial systolic dimension, and the duration of atrial fibrillation were 0.23 ± 0.10 mV, 60.4% ± 5.2%, 57.4 ± 8.2 mm, respectively, and 5.1 ± 4.6 years in the group with sinus rhythm, and were 0.06 ± 0.05 mV, 77.7% ± 10.3%, 95.3 ± 24.0 mm, respectively, and 11.8 ± 5.5 years in the group with atrial fibrillation. These parameters were all significantly different between the groups. Regarding atrial function, a transmitral flow A wave was detected in 66.7% and a transtricuspid flow A wave in 100%. Only the duration of atrial fibrillation had a significant influence on the restoration of left atrial function.
Conclusion: The maze III procedure was effective for atrial fibrillation associated with mitral valve disease. This procedure should be applied to patients with a cardiothoracic ratio less than 70% and a left atrial systolic dimension less than 80 mm.
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