4 . 2019

Effect of circular sympathetic denervation of pulmonary arteries on the degree of pulmonary hypertension in patients with mitral valve pathology and atrial fibrillation

Abstract

The aim is to analyze the influence of sympathetic denervation of the barrel and the orifices of the pulmonary arteries on the results of surgical treatment of atrial fibrillation in patients with dysfunction of the mitral valve, complicated by atrial fibrillation and severe pulmonary hypertension.

Material and methods. The analysis of surgical treatment of 140 patients with mitral valve disease, concomitant atrial fibrillation and high pulmonary hypertension (>40 mm Hg). Group study is presented of 51 patients (46 patients with severe mitral stenosis and 5 with insufficiency of mitral valve IV degree), all these patients underwent correction of dysfunction of the mitral lesions (47 mitral valve replacement and 4 mitral valve repair), butreally Maze IV procedure and further held denervation of the barrel and the orifices of the pulmonary arteries. A control group of 89 patients are shown patients at whom was also observed severe dysfunction of the mitral valve, atrial fibrillation and pulmonary hypertension >40 mm Hg, but unlike patients of the study group, denervation of pulmonary arteries was not carried out.

Results. On the basis of the conducted research work, it can be concluded that circular radiofrequency denervation of the trunk and the mouths of the pulmonary arteries, using a bipolar clamp- destructor, is a significantly effective method of correcting high secondary pulmonary hypertension, promotes remodeling of the heart cavities, in particular the left atrium and, as a consequence, improves the results of the Maze IV Procedure, by maintaining the sinus rhythm in patients with mitral valve dysfunction, complicated by atrial fibrillation and high pulmonary hypertension. It is necessary to continue the study of this technique with the involvement of more patients, analysis of long-term results and the use of this technique in patients with non-valvular causes of secondary pulmonary hypertension.

Keywords:secondary pulmonary hypertension, pulmonary trunk ablation, ganglion plexus denervation, mitral defect, atrial fibrillation

For citation: Trofimov N.A., Medvedev A.P., Babokin V.E., Dragunov A.G., Kichigin V.A., Nikol'sky A.V., Zhamlikhanova S.S. Effect of circular sympathetic denervation of pulmonary arteries on the degree of pulmonary hypertension in patients with mitral valve pathology and atrial fibrillation. Clin Experiment Surg. Petrovsky J. 2019; 7 (4): 32–41. doi: 10.24411/2308- 1198-2019-14004 (in Russian)

Received 24.04.2019. Accepted 31.10.2019.

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