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Transient sinus node dysfunction after the Cox-maze III procedure in patients with organic heart disease and chronic fixed atrial fibrillation

^a Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefässchirurgie, Berlin, Germany

View larger version (154K): [in a new window]   Figure 1 Artistic drawing of the left atrial part of the Cox-maze III procedure seen from the surgeon’s position standing on the patient’s right side. The procedure is performed from inside the left atrium: the left atrial appendage is excised and the pulmonary veins are completely encircled. Similarly to the heart transplantation, the heart is completely divided from all four pulmonary veins and the posterior part of the left atrium. This encircling incision is connected with the left appendicular incision and also—using a separate incision—with the mitral anulus (a cryolesion of the mitral valve anulus was not shown). All incisions are closed with continuous 3-0 and/or 4-0 polypropylene sutures. MV = mitral valve; LV = posterior wall of the left atrium; PV = left atrial ostia of the right pulmonary veins.

View larger version (113K): [in a new window]   Figure 2 Note the standard approach to the mitral valve (the interatrial grove incision of the left atrium) and three incision lines of the right atrium (surgeon’s view). The right atrial appendage was excised and a lateral incision was made downwards across the free wall of the right atrium. The next incision was made between the venae cavae, running parallel to the interatrial grove incision. It was prolonged to the left across the inferior part of the anterior right atrial wall, above the inferior vena cava and towards the right ventricle. RA = right atrium; PV = left pulmonary veins; VCS = vena cava superior; VCI = vena cava inferior.

View larger version (99K): [in a new window]   Figure 3 The operative field seen from the surgeon’s side after the operation is completed. RA = right atrium; PV = left pulmonary veins; VCS = vena cava superior; VCI = vena cava inferior; Ao = ascending aorta.