Left atrial reduction by posterior wall plication combined with mitral valve surgery in patients with a dilated left atrium

Abstract

Amac: Sol atrial genislemenin posteriyor plikasyon yontemiyle azaltilmasi ile atriyal fibrilasyon ve tromboembolik olaylarin engellenmesi amaclandi. Ca­lis­ma­pla­ni:­Mayis 2003 ile Ocak 2009 tarihleri arasinda 38 hastaya (17 erkek, 21 kadin; ort. yas 53.7±9.9 yil; dagilim 44-76 yil) posteriyor duvar plikasyonu ile sol atriyal kucultmeli mitral kapak cerrahisi ameliyati uygulandi. Bu calismada kronik atriyal fibrilasyon (AF) icin ne bipolar ne de unipolar kateter ablasyonu tedavisi uygulandi. Ayrica kronik AF icin radyofrekans ablasyonu uygulanan hastalar calismaya dahil edilmedi. Bul gu lar: Taburcu olduklarinda hastalarin 15’i (%39) sinus ritmindeydi. Takip sirasinda sinus ritmi 14 hastada (%37) geri dondu. Sol atriyumun ameliyat oncesi capi, ameliyat sonrasi 6. ayda 7.0±1.4 cm’den 4.6±0.5 cm’ye anlamli olcude azalmisti. So­nuc:­Sol atriyum boyut kucultulmesi basittir, az zaman alir, ayni zamanda sinus ritminin korunmasinda etkindir ve tek basina mitral kapak cerrahisi ile karsilastirildiginda herhangi bir ek mortalite ve morbiditeye neden olmaz. Anah tar soz cuk ler: Kalp kapak hastaliklari; mitral kapak; sol atriyum kucultme islemi. Background:­We aimed to reduce atrial fibrillation and thromboembolic events by reducing left atrial dilatation via posterior plication technique. Methods: Between May 2003 and January 2009, 38 patients (17 males, 21 females; mean age 53.7±9.9 years; range 44 to 76 years) underwent mitral valve surgery with left atrial reduction by posterior wall plication. Neither bipolar nor unipolar catheter ablation therapy for chronic atrial fibrillation (AF) was performed in this study. We also did not include patients in this study who had undergone radiofrequency ablation therapy for chronic AF. Results:­ At discharge, 15 patients (39%) were in sinus rhythm. During follow-up, sinus rhythm was restored in 14 patients (37%). Left atrium diameter was significantly reduced from 7.0±1.4 cm preoperatively to 4.6±0.5 cm at six months after surgery. Conclusion:­ In conclusion, left atrial size reduction is simple, takes less time, and is also effective in maintaining sinus rhythm without adding any additional mortality or morbidity compared to mitral valve surgery alone.