Rheumatic Valvular Heart Surgery and Maze III Procedure

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Drug treatment of AF usually leads to an unsatisfactory rate of recurrence. The Cox-maze III procedure for atrial fibrillation has been effective in restoring sinus rhythm in patients with mitral valve disease.
From September 2000 to September 2002, 10 consecutive patients with rheumatic mitral valve disease and chronic AF underwent the Cox-maze III procedure concomitantly with mitral valve replacement. Associated procedures were tricuspid valve repair in 4 patients and aortic valve replacement in 2 patients. Our indications to perform the Maze-III procedure were chronic AF, medical history of previous thromboembolic events and large left atrium on preoperative transthoracic echocardiography.
There were 2 men and 8 women with a mean age of 40±8 years. Mean aortic cross- clamp and cardiopulmonary bypass times were 90±11 and 144 ± 18 minutes, respectively. There was no in-hospital mortality. Normal sinus rhythm was restored early post-operatively in 60% and late in 80% of the patients. Right atrial and left atrial contractility was found in 80% and 70% of the patients in transesophageal
echocardiography 6 months postoperatively.
The maze III procedure associated with mitral valve replacement is a safe and effective surgical technique for conversing AF to sinus rhythm and restoring atrial contractility in rheumatic heart disease