Clinical Research On Left Atrial Reduction And Modified Maze In The Treatment Of Chronic Atrial Fibrillation In Rheumatic Heart Disease

ObjectiveTo evaluate the clinic effect of left atrial reduction(LAR) and modified maze procedure during mitral valve replacement in patients with chronic atrial fibrillation(CAF) and giant left atrium associated with rheumatic heart disease.Methods60 patients with CAF and giant left atrium(Left atrial volume index over 55mL/m2)associated with rheumatic heart disease were treated by modified maze procedure and mitral valve replacement ,among them ,30 patients underwent LAR on the same time (LAR group),the other 30 patients without LAR(control group). The changes of heart electricity activity and NYHA,LAD, LAVI,LVEF, and C/T were observed by using Electrocardiogram and Echocardiogram in all patients,and laboratory tests of plasma brain natriuretic peptide (BNP) were performed, and followed up for 1 year.ResultsThe rate of restoration to sinus rhythm was higher in LAR group than that in the control group (76.6%vs50.0%,p<0.01). The improvement of the NYHA classes was greater in LAR group than that in the control group (2.0±0.6vs1.1±0.5,p<0.01). A year after operation,the outcome of LAD,LAVI,LVEF,C/T in LAR group were prior to that in the control group (40±0.8mm,52.45±8.35 ml/m2,0.66±0.08,0.56±0.10)vs( 59±1.2mm,66.45±12.42ml/m2,0.56±0.12,0.64±0.11)(p<0.05). The plasma BNP in LAR group were more descent than that in the control group (170.35±62.15 vs628.57±212.35)(P<0.05)。ConclusionsFor the patients with chronic atrial fibrillation and giant left atrium associated with mitral valve disease, LAR combined modified maze procedure during mitral valvular replacement is an effective treatment in treating chronic atrial fibrillation, maintaining sinus rhythm and improving atrial and ventricular contraction functions. A successful maze procedure and left atrial reduction may significantly decreased plasma levels of BNP after surgery.