Combined treatment of mitral regurgitation and atrial fibrillation with valvuloplasty and the maze procedure

Successful mitral valve repair in a patient who continues to have chronic atrial fibrillation (AF) after surgery is only a limited success because of the ongoing risks with lifelong AF. For patients with AF for >1 year and left atrial diameter >60 mm, the likelihood of resuming sinus rhythm after mitral valve surgery was shown to be <10% in 1 series.¹ These patients may have impaired hemodynamic function as a result of loss of atrial contraction, symptomatic tachycardia, side effects from antiarrhythmic and anticoagulant drugs, and thromboembolic events. The Maze procedure, as originated by Cox et al,² is an operation designed to correct the consequences of AF by restoring normal sinus rhythm and atrial contraction in both atria. This report describes the use of this procedure for a patient undergoing mitral valve repair in whom the return of sinus rhythm was unlikely due to long-standing AF with dilated atria.