Asian Cardiovasc Thorac Ann 1999;7:164
© 1999 Asia Publishing EXchange Pte Ltd
An Incision-Sparing Modification of the Maze Procedure Using Electrocoagulation
Bhupesh Shah, MCh,
Deena Shah, MD,
Shakuntalla Calla, MD,
Varsha Shah, MCh
UN Mehta Institute of Cardiology
Civil Hospital Campus
Asharwa, Ahmedabad 380016, India
|
|
|
Cox's maze procedure is highly effective for chronic atrial fibrillation but it is very time consuming and the dissection, cutting, and suturing involved are cumbersome. Aortic cross-clamp and cardiopulmonary bypass times are prolonged. We recently used radiofrequency coagu-lation to produce the same physiological effect of interrupting the reentrant circuit without cutting and suturing. A microbipolar Valley Lab Force 4 (Valleylab, Inc., Boulder, CO, USA) electrosurgical unit was used for this purpose.
A 37-year-old female presented with dyspnea and palpitations of 2-years duration. On radiography, the cardiothoracic ratio was 0.65 with pulmonary plethora. Her electrocardiogram showed atrial fibrillation and incomplete right bundle branch block. An echocardiogram revealed a secundum atrial septal defect and left-to-right shunting.
The patient underwent corrective surgery through a midline sternotomy. Cardiopulmonary bypass was established with direct superior and inferior vena caval cannulation with right-angled metal-tipped cannulae. The right atrium was opened obliquely from the base of the right atrial appendage to the inferior vena cava. The right atrial appendage was amputated. Using bayonet-type micro-bipolar forceps with an active tip length of 7 mm, the right atrium was electrocoagulated with an output of 45 watts, starting from the superior vena cava to the inferior vena cava, parallel to the interatrial septal groove. The midpoint of this pathway was joined to the Waterston groove transversely. The lower end of this track was electrocoagulated obliquely towards the posteroseptal commissure of the tricuspid valve to within 1 cm of the annulus. Another linear coagulation was started from the base of the right atrial appendage to the anteroseptal commissure of the tricuspid valve to within 1 cm of the annulus and also from the base of the right atrial appendage to the anterior aspect of the superior vena cava. The interatrial septum superior to the atrial septal defect was coagulated vertically towards the superior vena caval opening. Direct closure of the atrial septal defect was performed with a cross-clamp time of 22 minutes. The patient came off bypass after 47 minutes with normal sinus rhythm and did not require any postoperative inotropic support. At a follow-up examination 3 months later, the patient was well and in normal sinus rhythm.
References
-
Patwardhan AM, Dave H, Tamhane M, Pandit SP, Dalvi BV, Golam K, et al. Intraoperative radiofrequency micro-bipolar coagulation to replace incisions of maze III pro-cedure for correcting atrial fibrillation in patients with rheumatic valvular disease. Eur J Cardio-thorac Surg
1997; 12
:627
–33.[Abstract]
-
Cox JL, Boineau JP, Schuessler RB, Jaquiss RDB, Lappas DG. Modification of maze procedure for atrial flutter and atrial fibrillation. Rationale and surgical results. J Thorac Cardiovasc Surg
1995; 110
:473
–84.[Abstract/Free Full Text]
