Post-op: mitral, maze

[Paul C]

I had an mitral valve repair and the maze procedure on 11/2/2000 at CCF( McCarthy, Jaber et.al.). I have a soreness in the right shoulder that feels like I slept on it wrong or pinched a nerve.  There is an attendant tingling in my right wrist an thumb area. One night I felt a deep tightness and modrate pain in my right shoulder blade for about 10 minutes. Normal? Common? Concern? The left side is ready for 18 - feels great.
The maze. Any pictures,illustrations or description of the proceedure? Does it have a greater chance of maintaining sinus as the scarring is completed  or is what you see initially what you get. I was flipping back and forth at CCF. I'm on Rythmol, Capoten and baby asperin.  I was previously converted twice w/o success before the maze (sinus would last for a few days). Is there an increased conversion sucess after the maze?  What does the data base look like.
Thanks
Paul C.

[Chris S.]

Paul:

I had a mitral repair in 5/00. My surgeon's group is pioneering the radio frequency ablation "maze" type surgery. He essentially scarred a pattern around the pulmonary veins and two side lines to prevent re-entry circuits. This procedure added only 8-10 minutes to bypass. I had only some intermittently brief a-fib prior to surgery but A large left atrium. I felt this was worth the risk given that 30-35% of mitral pts have a-fib post-op. I have had a recent increase in palpitations but no known a-fib.

As for chest soreness, I took 3 mos to be able to sleep on my side and whenever I do chest exercise I still crackle a bit. By all means do cardiac rehab if you can, it gives you a real boost. Good Luck

[Cleveland Clinic, MD]

Dear Paul,
During a major heart operation a number of the nerves are stretched and some are cut.  Eventually most of these will grow back to normal but in the post-operative period it is not unusual to have a variety of aches and nerve pains.  If these continue or increase in intensity however they should be evaluated.  

The maze procedure is a surgery for atrial fibrillation that places a number of incisions in the atrium of the heart.  There is a delay in the time between the surgery and when the scar formation is complete.  Usually we wait until up to 6 months post-op before we decide if the procedure was a success or failure.  Dr. McCarthy has not published his data yet but in other studies there was a greater than 90% success rate in maintaining sinus rhythm.  Sometimes medical therapy will still be required.

Here is a link to find more info on the maze.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010746926