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We summarize the Cox-Maze IV procedure concomitant with valvular surgery performed in patients with situs inversus dextrocardia at this institution.
Atrial fibrillation (AF) is the most common cardiac arrhythmia. The use of ablation technologies made the Cox-Maze IV procedure (CMP-IV) technically easier, faster, becoming the gold standard for the surgical treatment of AF. However, the efficacy and safety of CMP-IV in situs inversus dextrocardia are largely unknown. This paper summarizes the CMP-IV procedure performed concomitantly with valvular surgery in patients with situs inversus dextrocardia at this institution.
From February 2016 to September 2020, three dextrocardia patients with persistent AF and valvular diseases were referred to this institution for valvular and CMP-IV surgery. CMP-IV was performed using either cryoablation with a nitrous oxide (N2O)-based cryoprobe or a bipolar radiofrequency clamp and bipolar radiofrequency pen. Mechanical valve replacement or mitral vavuloplasty was performed in another patient in addition to tricuspid annuloplasty. Transmurality of the ablated atrial tissues was evaluated by electron microscopy. Heart function was assessed by transthoracic echocardiography. Cardiac rhythm was monitored by 24 h Holter at 3, 6, 12, 18, 24, and 48 months follow-up.
All the AF was successfully eliminated in the ablation procedure without recurrence or other complications during hospitalization. The mean bypass and crossclamp times were similar in all the patients. The postoperative ventilator support time, the duration of stay in the ICU, and postoperative residence time were also not significantly different among the patients. Transmural atrial necrosis was detected in the ablated atrial tissues. Sinus rhythm maintenance was achieved at 3, 6, 12, 18, 24, and 48 months follow-up in all the patients. All valve protheses switched freely; no tricuspid regurgitation was observed. The results of the present study demonstrate that the CMP-IV is safe and effective in eliminating AF in dextrocardia patients concomitant with valvular surgery.
Dextrocardia is a rare, congenital cardiac malformation in which the axis of the heart is indexed to the right side of the thoracic cavity. Dextrocardia with situs inversus totalis refers to all visceral organs, including the heart, being mirrored and is extremely rare1,2. Atrial fibrillation (AF) is the most common arrhythmia that affects millions of people and causes substantial morbidity and mortality, especially with respect to the increased risk of stroke3.
A literature survey was unable to demonstrate a definitive approach for the concomitant Cox-Maze p....
The Institutional Review Board approved the study protocol, and samples of the dilated left atrium (LA) tissues in the dextrocardia cases were collected for electron microscopy after written informed consent had been obtained.
1. Surgical procedure and ablation
Surgical procedure and early postoperative period
A mechanic MV replacement, tricuspid annuloplasty, and concomitant cryo-CMP-IV were performed simultaneously for the first patient. The second had undergone surgery of mechanic AV replacement, tricuspid annuloplasty, and concomitant cryo-CMP-IV. In the third patient, a biatrial CMP-IV procedure was performed simultaneously with mitral valvuloplasty and tricuspid annuloplasty. All operations were smooth, and each beating heart restored SR after resus.......
Dextrocardia is a group of rare heart defects in which the heart is situated on the right side of the thoracic cavity instead of on the left side. One-third of all dextrocardia cases are mirror-image cases, which means the orientation of the cardiac chambers is a mirror image to levocardia (normally situated heart)12. It is estimated that situs inversus dextrocardia associated with situs inversus totalis occurs with an incidence of much less than 1 in 10,000-50,000 births1<.......
The authors have no conflicts of interest to disclose.
We thank the patients for participating in this study. We are also grateful to the Biomedicine Electron Microscopy Laboratory of Basic Medical Science School of Central South University, particularly to Xiaoying Wu and Jin Li for technical support. This work was supported by the National Key Research and Development Program (No. 2018YFC1311204).
....Name | Company | Catalog Number | Comments |
CryoICE | AtriCure, Cincinnati, Ohio | CRYO2 | Cryoablation in case 1 and case 2 was performed exclusively using it with a flexible 10cm in length metal cryoprobe. |
Medtronic Open Pivot Standard mechanical MV | Medtronic, Minneapolis, Minn | 709291 / MHV 500DM27 STD MITRAL | A 27-mm MV was adopted in case 1. |
Medtronic Open Pivot Standard mechanical AV | Medtronic, Minneapolis, Minn | 646871 / MHV 500FA23 STD AORTIC | A 23-mm AV was adopted in case 2. |
bipolar radiofrequency pen | AtriCure Inc., Cincinnati, OH | Maze-IV in case 3 | |
bipolar radiofrequency clamps | AtriCure Inc., Cincinnati, OH | Maze-IV in case 3 | |
Goretex | W.L. Gore & Associates, Inc., Elkton, Maryland | A surgical suture made of polytetrafluoroethylene. | |
rigid mitral ring | Kingstron Bio, Suzhou, China | Element Force ARM32 | A 32 mm ring was adopted in case 3. |
Tricuspid Sovering Band | Sorin Group Italia S.r.l., VC, Italy | SBG0730 / SB30T | A 30 mm ring was adopted in case 1. |
Tricuspid Sovering Band | Sorin Group Italia S.r.l., VC, Italy | SQB0240 / SB30T | A 30 mm ring was adopted in case 2. |
Tricuspid Sovering Band | Sorin Group Italia S.r.l., VC, Italy | SBF0930 / SB28T | A 28 mm band was adopted in case 3. |
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