Abstract: Objective To summarize the experiences of radiofrequency modified maze procedure for atrial fibrillation (AF) in patients with mitral valve diseases. Methods From May 2003 to December 2008, 122 patients, including 31 males and 91 females, with permanent AF underwent radiofrequency modified maze procedure as a combined operation with mitral valve replacement. Their age ranged from 23 to 65 years old (47±10 years). The duration of AF varied from 0.5 to 32.0 years (6.5±5.7 years). There were 57 cases of stenosis, 7 cases of regurgitation and 58 cases of both stenosis and regurgitation. Ablation lines were made with Cardioblate (Medtronic, monopolar, 25.30 W, 180.240 ml/h). After rightsided maze procedure was finished, aorta was crossclamped and cold crystalloid or blood cardioplegia were delivered for myocardial protection. Left atrial incision was performed through the interatrial groove or interatrial septum. The ablation lines were created to encircle the orifices of the left and right pulmonary veins respectively. The ablation lines were also performed from the left encircling line to the posterior mitral valve annulus and to the orifice of left atrial appendage respectively. An ablation line was used to connect the circumferential line of left and right pulmonary veins. The left atrial appendage was tied and concomitant operations were performed. Amiodarone was given to the patients after operation and regular follow-up was done. Results There were four perioperative deaths including 2 cases of multiple organ failure, 1 case of mechanic valve obstruction and 1 sudden death. Follow-up was done to 115 patients for 1.5-7.0 years (4.8±2.6 years) with three cases lost. During the followup period, four patients died, including 3 sudden deaths and 1 case of prosthetic obstruction. Eightyseven patients (78.4%, 87/111) recovered to sinus rhythm; 22 patients still had AF; 1 patient had atrial flutter; and 1 patient required a permanent pacemaker one year after the operation. Diameter of left atrium after operation (0.5-7.0 years) was decreased compared with that before operation（44.90±7.50 mm vs. 54.30±10.80 mm，t＝10.641，P＝0.000）. Conclution Radiofrequency modified maze procedure for AF in patients with mitral valve disease is relatively safe. But heart rhythm instability, tachyarrhythmia and recurrent AF are not rare for those patients. Therefore, the surgical indication of AF should be individualized.
Objective To summarize the clinical characteristics and management experiences of patients with severe tricuspid regurgitation (TR) after mitral valve surgery. Methods Thirty patients were followed up and reviewed for this report. There were 1 male and 29 female patients whose ages ranged from 32 to 65 years (47.1±92 years). A total of 28 patients had atrial fibrillation and 2 patients were in sinus rhythm. There were 13 patients of mild TR, 10 patients of moderate TR and 7 patients of severe TR at the first mitral valve surgery. Five patients received the tricuspid annuloplasty of De Vega procedure at the same time, 2 patients received Kay procedure. The predominant presentation of patients included: abdominal discomfort (93.3%, 28/30), edema (66.7%,20/30), palpitation (56.7%, 17/30), and ascites (20%, 6/30). Results Nine patients underwent the secondary surgery for severe TR. The secondary surgery included tricuspid valve replacement (6 cases), mitral and tricuspid valve replacement (2 cases) and Kay procedure (1 case). Eight patients were recovered and discharged and 1 patient died from the bleeding of right atrial incision and low output syndrome. Twentyone patients received medical management and were followed up. One case was lost during followup. Conclusion Surgery or medical management should be based on the clinical characteristics of patients with severe TR after mitral valve surgery. It should be based on the features of tricuspid valve and the clinical experience of surgeon to perform tricuspid annuloplasty or replacement.
Objective To report the preliminary results of intraoperative saline-irrigated radiofrequency modified maze procedure for chronic atrial fibrillation (AF) in mitral valve diseases. Methods From May 2003 to April 2004 forty-one patients underwent intraoperative saline-irrigated modified maze procedure. The patients included 13 male and 28 female. Their age ranged from 27-65 years (46±10 years). The duration of AF varied from 5 months to 15 years (4.5±3.6 years).The left atrial diameter varied from 37-93 mm (54±11mm). There were mitral stenosis 20, mitral regurgitation 1 and mitral stenosis with regurgitation 20 cases. Cardiopulmonary bypass (CPB) was established as usual. Ablation lines were made with Cardioblate (Medtronic, 25-30 W, 180-240ml/h). Having finished right-sided maze procedure, the aorta was cross-clamped and cold crystalloid or blood cardioplegia were used for myocardial protection. Left atrial incision was performed through the interatrial groove. The ablation lines were created to encircle the orifices of the left and right pulmonary veins respectively. The ablation lines were also performed from the left encircling line to the posterior mitral valvular annulus and to the orifice of left atrial appendage respectively. A ablation line was used to connect left and right pulmonary veins circumferential line. Concomitant procedures were performed (there were double valve replacement 10 cases, mitral valve replacement 31 cases, tricuspid annuloplasty 6 cases, removing the left atrial thrombi 6 cases). Results CPB time varied from 71-160 min (105±24 min) and cross-clamping time varied from 32-106 min (62±20 min). The ablation time varied from 4-22 min (11±4 min). One patient died during hospitalization and the death was caused by acute mechanic valve obstruction. During follow-up at discharge and 3 months 35% patients (14/40) were free of AF and the others were not. But at 6 months 67% patients (10/15) were free of AF. Conclusion The intraoperative saline-irrigated radiofrequency modified maze procedure is comparatively simpler and its efficacy is satisfactory.