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ORIGINAL ARTICLE

Maze operation (Cox) without croablation for surgical treatment of atrial fibrillation

Francisco Gregori JrI; Celso CordeiroII; Marcos GoulartII; Nilson CoutoII; Valmir RosaII; Samuel S SilvaI; Luciano FaçanhaII; Osney MoureII; Icanor RibeiroII; Walace AquinoII; Sérgio HayashiII; Ricardo RezendeII; Antônio Nechar JrII

DOI: 10.1590/S0102-76381993000300006

ABSTRACT

Six patients with atrial fibrillation were submitted to maze operation (Cox) without crioablation. Four patients had also mitral stenosis, one had mitral insufficiency and one mitral insufficiency plus mitral stenosis. The mean left atrium diameter was 6.0 cm (5-7.3) in the preoperative ecodopplercardiogram. The ethiology was rheumatic in all but one patient. Conservative mitral valve surgery was performed in five patients and mitral valve replacement in one. Thrombosis of the left atrium was present in four patients. The mean cross-clamping time was 91 minutes (80-108). In the operating room, sinus rhythm was observed in two patients and junctional rhythm in four. In the first postoperative day all patients were in junctional rhthminfour. In the firstpostoperative day all patients were in junctional rhythm. The Holter (24 hours) in the eighteeth postoperative day showed sinus rhythm in five and atrial ectopic rhythm in one. The hemodynamic data and the ecodoppler showed synchronic left atrial contraction in all but one patient and a mean left atrium diameter of 4.8 cm (3.7-5.2). The patients discharged from hospital (8-27 days) are in excellent conditions.

RESUMO

Seis pacientes foram submetidos ao tratamento cirúrgico da fibrilação atrial (FA) pela técnica do labirinto (Cox), sem a uitilização da crioblação. Quatro pacientes apresentavam estenose mitral (EM) associada, 1 insuficiência mitral e 1 dupla lesão mitral. Um dos pacientes apresentava estenose tricúspide e 2 insuficiênciatricúspide associadas. O diâmetro médio do átrio esquerdo, medido pelo ecocardiograma era de 6,0 cm (5-7,3). A etiologia era reumática em 5 pacientes e degenerativa em 1. Plastia valvar mitral foi realizada em 3 pacientes, comissurotomia mitral em 2 e troca valvar mitral em 1. Em 4 pacientes havia trombos no átrio esquerdo, um deles também no átrio direito. O tempo médio de circulação extracorpórea foi de 123 minutos (110-142) e de anóxia do miocárdio de 91 minutos (80-108). Na sala de operações o ritmo inicial era juncional em 4 e sinusal em 2. No pós-operatório imediato, todos apresentavam ritmo juncional, passando para ritmo sinusal em todos, exceto em 1. Os pacientes receberam alta hospitalar (8-27 dias) em boas condições, sem utilização de drogas antiarrítmicas e o Holter de 24 horas mostrava ritmo sinusal em 5 pacientes e ritmo atrial ectópico em 1 paciente. O estudo hemodinâmico e o ecodoppler revelaram contração atrial sincrónica em todos os casos, exceto em 1. O diâmetro atrial esquerdo médio era de 4,8 cm (3,7 - 5,2).
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REFERENCES

1. COX, J. L. - The surgical treatment of atrial fibrilation: IV. Surgical technique. J. Thorac. Cardiovasc. Surg., 101: 584-592, 1991. [MedLine]

2. COX, J. L.; CANAVAN, T. E.; SCHUESSLER, R. B. - The surgical treatment of atrial fibrilation: II. Intraoperative eletrophysiologic basis of flutter and atrial fibrillation. J. Thorac. Cardiovasc. Surg., 101: 406-426, 1991. [MedLine]

3. COX, J. L.; SCHUESSLER, R. B.; BOINEAU, J. P. - The surgical treatment of atrial fibrillation: I. Summary of the current concepts of the mechanisms of atrial flutter and atrial fibrilation. J. Thorac. Cardiovasc. Surg., 101: 402-405, 1991. [MedLine]

4. COX, J. L.; SCHUESSLER, R. B.; D'AGOSTINO, H. J. - The Surgical treatment of atrial fibrillation: III. Development of a definitive surgical procedure. J. Thorac. Cardiovasc. Surg., 101: 569-583, 1991. [MedLine]

5. JATENE, A. D.; SOSA, E.; TARASOUTCHI, F. JATENE, M. B.; POMERANTZEFF, P. - Tratamento cirúrgico da fibrilação atrial. Procedimento do "Labirinto": experiência inicial. Rev. Bras. Cir. Cardiovasc., 7: 107-111, 1992.

6. McCARTHY, P. M.; CASTLE, L. W.; MALONEY, J. D. - Initial experience with the maze procedure for atrial fibrillation. J. Thorac. Cardiovasc. Surg., 105: 1077-181, 1993.

Article receive on Friday, October 8, 1993

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