[Evaluation of modified maze procedure by Doppler tissue imager]

Since 1998 the cardiac surgeons of WCUMS have performed modified maze procedure for treating the patients with rheumatic mitral valve disease accompanied with chronic atrial fibrillation (Af). In this study, echocardiography, especially Doppler Tissue Imager (DTI), was used to evaluate atria contraction and function of such patients before and after the operation. 14 rheumatic mitral disease patients, aged 27-60 years, were chosen; among them, 11 had mitral stenosis, 3 mitral regurgitation. The control group consisted of 16 cases, aged 24-67 years, with normal echocardiogram. Before and half-1 year after the operation, left atrium, left ventricle, right atrium and ventricle were measured, and cardiac function and posterior wall motion of left atrium were measured. Velocity of mitral valve annual and tricuspid valve annual was measured in DTI. The results showed: There was no age difference between the two groups. The motion of posterior wall of left atrium was 4.18 +/- 0.37 mm in the operation group, 4.09 +/- 0.29 mm in the control group (P > 0.05). No difference in velocity of mitral/tricuspid valve annual between the two groups was observed; 3 peaks of mitral valve annual were S 0.11 +/- 0.02, e 0.11 +/- 0.01, a 0.09 +/- 0.01 (m/s) in operation group, and S 0.08 +/- 0.00, e 0.10 +/- 0.01, a 0.08 +/- 0.01 (m/s) in control group, (P > 0.05, respectively); 3 peaks of tricuspid valve annual were S 0.10 +/- 0.01 vs 0.11 +/- 0.08, e 0.11 +/- 0.08 vs 0.10 +/- 0.01, a 0.10 +/- 0.10 vs 0.09 +/- 0.01 (m/s), (P > 0.05, respectively). The diameter of left atrium after operation in cases of mitral stenosis decreased significantly, compared with that before operation (P < 0.01). The diameter of right atrium after operation decreased significantly, compared with that before operation (P < 0.01). There was no significant change in right ventricle/left ventricle/EF and FS. The diameter of left atrium after operation in cases of mitral regurgitation decreased significantly, compared with that before operation (P < 0.01). The diameter of left ventricle after operation decreased significantly, compared with that before operation (P < 0.05). No significant change in right ventricle/right atrium/EF and FS was noted. The authors conclude the DTI, as a new diagnostic method in echocardiography, has high sensitivity and is less influenced when used to observe motion of atrium-ventricle annual influenced. It can avoid the error caused by deviation of blood displacement. In the rheumatic mitral valve disease patients who had mitral valve replacement and modified maze procedure, atrial contraction respores, the risk of thromboembolism decreases and prognosis improves. So the operation is worth doing.