Modified cox maze procedure for atrial fibrillation with mitral valve diseaset.

OBJECTIVE: To determine early term results of the modified Cox maze procedure for curing atrial fibrillation (AF) associated with mitral valve disease. METHOD: Between January and December 2000, 10 consecutive patients with AF underwent the modified Cox maze procedure with mitral valve repair in 2 and replacement in 8. The associated procedure included 3 aortic valve replacements, 1 tricuspid annuloplasty, and 2 atrial septal defect closures. There were 5 males and 5 females, with ages ranging from 19 to 52 years (mean = 38.3 years). Pre-operative-existing AF time varied from 4 to 146 months (mean = 41.1 months), and left atrial dimension varied from 4.50 to 6.89 cm (mean 5.51 cm). The authors modified the maze atriotomies to preserve the sinus node artery and used cryoablation, incision and suture to simplify the procedures. RESULTS: Seven cases (70%) regained sinus rhythm and 3 cases (30%) still remained in AF. Two cases (double valve replacement) needed intraaortic balloon pump. Two of them developed cardiac tamponade 1 month post-operatively, (one in sinus rhythm case and another one in AF). Those 3 patients who remained in AF had a longer pre-operative existing AF-time and larger left atrial dimension but it was insignificant (p = 0.227 and p = 0.187 respectively). There was no early or late mortality. CONCLUSION: The pertaining results suggest that the modified Cox maze procedure has satisfactory effectiveness to cure atrial fibrillation, restore atrioventricular synchrony and preserve atrial transport function in the patients having AF associated with mitral valve disease.

Correction of truncus arteriosus using a fresh autologous pericardial trileaflet valve conduit.

A fresh autologous pericardial trileaflet valve conduit was used in a 5-month-old infant for correction of truncus arteriosus. The patient recovered from the operation with satisfactory hemodynamics and post-operative echocardiogram at 3 months showed only mild to moderate pulmonary regurgitation. This technique is a useful alternative for correction in an infant with congenital heart disease who needs a tissue valve conduit. It may be more suitable than an aortic homograft by reason of unavailability of small homograft and limitation of organ donation.