大動脈弁置換術施行例における両心房maze手術

Bilateral Atrial Maze without Left Atrial Incision during Aortic Valve Replacement

心房細動（atrial fibrillation：Af）に対する標準的外科治療はmaze手術であり，良好な心房細動再発予防効果が報告されている1）．左房切開を伴わない大動脈弁置換術（aortic valve replacement：AVR）の際には肺静脈隔離術（pulmonary vein isolation：PVI）のみ併施されることが多い2）．

A 77-year-old man had severe aortic stenosis and continuous atrial fibrillation. We performed maze procedure without left atrial incision （Dallas lesion set） during aortic valve replacement for this patient. Dallas lesion set alternates the isolation of mitral isthmus by connecting ablation line beneath left coronary cusp and noncoronary cusp commissure of the aortic valve with ablation from epicardial side of the upper left atrium. Isolation of posterior wall of the left atrium is completed by ablation from the hole for venting tube at the right inferior pulmonary vein. We have had six cases of maze surgery with Dallas lesion set during aortic valve replacement. All patients were in sinus rhythm at discharge, and there was no bleeding complication or in-hospital death. This technique may be a safe and convenient alternative to maze procedure in patients with persistent atrial fibrillation who are refractory to pulmonary vein isolation alone.