Triangular Plasty of Left Atrium in Surgical Treatment of Left Atriomegaly
Aim. The aim was to determine the possibilities of left atrium (LA) reduction by triangular plasty of LA (TPLA) during mitral valve replacement (MVR). Isolated surgical correction of mitral defect (mitral valve replacement or plasty [MVP]) in the presence of uncorrected left atriomegaly is associated with the long-term manifestation of heart failure with the risk of thromboembolic complications and the absence of reversion to sinus rhythm. The treatment outcomes in patients with isolated mitral defect and left atriomegaly, who were undergoing surgical treatment at the Department of Surgery of Acquired Heart Defects of the Institute were analyzed. The analyzed group included 137 patients. All the patients underwent MVP combined with the original technique of triangular plasty of LA. Among 137 operated patients, 3 (2.2%) died. The changes in echocardiographic parameters at the treatment stages were as follows: LV ejection fraction 0.51 ± 0.05 (preoperative), 0.54 ± 0.05 (postoperative), and 0.56 ± 0.05 (remote). The LA diameter (mm) was 65.5 ± 3.8 (preoperative), 51.5 ± 2.1 (postoperative), and 52.5 ± 2.2 (remote). The technique is less traumatic and outlines an effective procedure which leads to a significant improvement in the LA morphometry and is accompanied by a low risk of hospital mortality.
Materials and methods. From 1.10.2010 to 1.01.2019, 137 adult patients (pts) with mitral valve disease (MVD) and giant LA (¤60 mm in diameter) underwent surgical intervention at the Institute. MVR was performed in all the pts. TPLA including ligation of LA auriculum was performed in all the pts. All operations were performed with cardiopulmonary bypass and moderate hypothermia with crystalloid cardioplegia.
Results. There were 3 hospital deaths. Echocardiography showed that LA diameter (mm) was 65.5 ± 3.8 (preoperative), 51.5 ± 2.1 (postoperative), and 52.5 ± 2.2 (remote).
Conclusions. TPLA during isolated MVR to improve LA morphometry during the postoperative period.
- American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease); Society of Cardiovascular Anesthesiologists, Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease. J Am Coll Cardiol. 2006;48(3):e1–148. https://doi.org/10.1016/j.jacc.2006.05.021
- Knyshov GV, Bendet YaA. [Acquired Heart Diseases]. Kyiv; 1997. Russian.
- La Meir M. Surgical options for treatment of atrial fibrillation. Ann Cardiothorac Surg. 2014;3 (1):30–7. https://doi.org/10.3978/j.issn.2225-319X.2014.01.07
- Prabhu S, McLellan AJ, Walters TE, Sharma M, Voskoboinik A, Kistler PM. Atrial structure and function and its implications for current and emerging treatments for atrial fibrillation. Prog Cardiovasc Dis. 2015;58(2):152–67. https://doi.org/10.1016/j.pcad.2015.08.004
- Masoudi FA, Calkins H, Kavinsky CJ, Slotwiner DJ, Turi ZG, Drozda JP Jr, et al. 2015 ACC/HRS/SCAI left atrial appendage occlusion device societal overview: a professional societal overview from the American College of Cardiology, Heart Rhythm Society, and Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv. 2015;86(5):791–807. https://doi.org/10.1002/ccd.26170
- January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1–76. https://doi.org/10.1016/j.jacc.2014.03.022
- Knyshov GV, Mnishenko VI, Popova EV, Popov V.V. [Surgical treatment of mitral stenosis complicated by massive thrombosis of left atrium].Ukrainian Journal of Cardiology. 2012;( Suppl 1):162. http://doi.org/10.1314.jacc.2012.03.25
- Popov VV, Bolshak AA, Pukas EV, Lazoryshynets VV. [Reduction of Left Atrium during Isolated Replacement of Mitral Valve]. Surgery. Eastern Europe. 2016;5(4):513–7. Russian. http://doi.org/10.1016.j.Pcad.2015.08.006
- Popov VV, Pukas EV. [Mitral valve surgery with left atrial plasty on atriomegaly]. Ukrainian Journal of Cardiology. 2018;( Suppl 1):132. Russian. http://doi.org/11.1122/jacc.2018.04.11
- Pukas KV, Roy VV, Trembovetska OM. [The role of the left atrial diameter in the restoration of sinus rhythm in mitral valve replacement]. Ukrainian Journal of Cardiology.2017;(Suppl 1):125. Ukrainian. http://doi.org/10.2123/jacc.2017.01.22