Objective    To analyze the clinical characteristics of rheumatic heart valve disease (RHVD) with atrial fibrillation (AF) and the relationship between clinical factors and the progress of AF

   and to discuss the surgical treatment of RHVD with atrial fibrillation.     Methods    Retrospective analysis was conducted on 483 patients [143 men and 340 women

   aged 22-74 (45.23±11.51)] who received mitral valve replacement from March 2008 to June 2009 in Xinqiao Hospital

   China. The patients included 355 cases with simple mitral valve disease and 128 cases with mitral valve and aortic valve diseases. Fifty-one of the patients suffered from left atrial thrombus

and 4 had suffered from cerebral embolism. During mitral valve replacement

10 cases underwent endocardial ablation using argon beam diathermy

26 cases left atrial plication

and 127 cases tricuspid valvuloplasty and tricuspid valve replacement (21 cases using the Carpentier ring). All the patients were divided into a chronic AF (cAF) group

a paroxysmal AF (pAF) group

and a sinus rhythm (SR) group according to AF incidence and duration. The right atrial specimens (formalin-fixed paraffin-embedded tissue blocks) of 5 random cases in each group were sectioned and treated through Masson’s trichrome staining to detect atrial fibrosis and measure collagen volume fraction (CVF).     Results    The CVF of right atrium in the pAF group was significantly higher than that in the SR group (P0.05). Compared with the SR and pAF groups

the cAF group had a significantly higher CVF of right atrium (P0.05). The extracorporeal circulation time was (90.27±46.86) min in operation. Eight deaths occurred after operation

with a mortality rate of 1.66%. After operation

9 cases received thoracotomy for hemostasis

and perivalvular leakage was found in 2 cases. The mechanical ventilation duration after operation was (11.20±5.87) h. Eight of ten patients who underwent endocardial ablation had AF to sinus rhythm conversion.     Conclusion    RHVD accelerates the progress of AF. The degree of right atrial fibrosis increases with the duration of AF. The valve replacement along with maze procedure as well as applying antiarrhythmic drug early after operation is an effective means of treating RHVD with AF.