目的 总结风湿性心瓣膜病合并心房颤动的发病特点和外科治疗经验。 方法 回顾性分析1998年12月至2004年11月期间收治的546例风湿性心瓣膜病合并心房颤动患者的临床资料，其中行二尖瓣置换术383例，主动脉瓣置换术5例，二尖瓣和主动脉瓣双瓣膜置换术158例。在心脏不停跳下手术459例，常规体外循环心脏停搏下手术87例；术中同期行改良Cox迷宫III型手术13例，左心房折叠术45例，三尖瓣成形术245例。 结果 全组患者均顺利完成手术，体外循环时间59～219min。术后早期死亡10例（1.83%, 10/546) ，死于多器官功能衰竭和急性呼吸窘迫综合征。术后早期发生血色素尿11例，早期二次开胸探查止血7例，瓣周漏2例，均经相应的处理治愈。术后随访387例，随访时间1年，随访结果：窦性心律自动转为心房颤动17例，未接受迷宫手术由心房颤动转为窦性心律12例，13例接受迷宫手术患者术后心房颤动均转为窦性心律。远期死亡2例,分别死于出院后18个月和23个月。其余患者无严重的出血和血栓栓塞并发症发生。 结论 风湿性二尖瓣关闭不全较二尖瓣狭窄更易引发心房颤动，但发生左心房血栓的几率减小，浅低温心脏不停跳心瓣膜置换术结合双心房迷宫手术可作为治疗心瓣膜病合并心房颤动的一种有效手术方法。
Citation：
马瑞彦,肖颖彬,钟前进等. 风湿性心瓣膜病伴心房颤动546例临床分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2007, 14(6): 473-. doi:
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- 1. Nattel S. New ideas about atrial fibrillation 50 years on. Nature, 2002, 415(6868): 219-226.
- 2. Verheule S, Wilson E, Everett T 4th, et al. Alterations in atrial electrophysiology and tissue structure in a canine model of chronic atrial dilatation due to mitral regurgitation. Circulation, 2003, 107(20):2615-2622.
- 3. Chen MC, Chang JP, Chang HW. Preoperative atrial size predicts the success of radiofrequency maze procedure for permanent atrial fibrillation in patients undergoing concomitant valvular surgery. Chest, 2004, 125(6): 2129-2134.
- 4. Ozkan M, Kaymaz C, Kirma C, et al. Predictors of left atrial thrombus and spontaneous echo contrast in rheumatic valve disease before and after mitral valve replacement. Am J Cardiol, 1998,82 (9):1066-1070.
- 5. Kranidis A, Koulouris S, Filippatos G, et al. Mitral regurgitation protects from left atrial thrombogenesis in patients with mitral valve disease and atrial fibrillation. Pacing Clin Electrophysiol, 2000, 23(11 Pt 2):1863-1866.
- 6. 马长生，主编.心房颤动--临床实践与治疗进展. 北京：人民卫生出版社， 2005, 95-103.
- 7. 陈如坤，王永清，陈勇兵, 等. Cox迷宫III型手术同期换瓣治疗风湿性二尖瓣病变伴房颤. 中华医学杂志，2002, 82 (12) : 815-817.
- 8. 肖颖彬,陈林,王学锋,等.浅低温体外循环心脏跳动中心内直视手术1032例临床分析.第三军医大学学报,2001,23(5):502-504.
