Complete Reconstruction of the Left Heart with Atriomegaly and Ventriculomegaly: Clinical Case
Abstract
Implementation of the principles of medical preparation, comprehensive reconstruction of the left heart in patients with atriomegaly and ventriculomegaly and combined mitral-tricuspid valve diseases leads to improvement of myocardial function and morphometric parameters of the left atrium (LA) and left ventricle (LV).
Case description. Patient R., male, 67 years old, underwent examination and treatment from April 22 to May 25, 2021 at the department of surgical treatment of acquired heart diseases of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with the diagnosis of stage IV mitral regurgitation, stage IV tricuspid insufficiency, high grade pulmonary hypertension, permanent atrial fibrillation (lasting 10 years since 2011), IIB heart failure with reduced left ventricular ejection fraction (LVEF), secondary hypothyroidism (state of drug subcompensation). Upon admission, the patient was in a state of circulatory decompensation, which required long-term medical preparation for the operation. After his condition was improved, the patient underwent surgery: mitral valve replacement with complete preservation of the valve apparatus, triangular plasty of LA, tricuspid valve plasty with the imposition of a support ring and resection of the right atrium. There were no complications during the intraoperative period. The postoperative period was characterized by symptoms of hyperbilirubinemia, increased exudation from drainages on the first day after surgery. After appropriate treatment, the patient’s condition was stabilized. The patient was discharged on the 13th day after surgery with improvement.
Conclusion. Given the initial severe condition of the patient with advanced heart disease with reduced LVEF, left atriomegaly 9.5x12.3 cm, high grade pulmonary hypertension (peak systolic pressure = 70 mm Hg) and comorbidities, comprehensive reconstruction of the left heart with atriomegaly and ventriculomegaly leads to improvement of functional state of the myocardium and morphometric parameters of LA and LV.
References
- Kurfirst V, Mokráček A, Krupauerová M, Canádyová J, Bulava A, Pešl L, et al. Health-related quality of life after cardiac surgery – the effects of age, preoperative conditions and postoperative complications. J Cardiothorac Surg. 2014;9:46. https://doi.org/10.1186/1749-8090-9-46
- Popov VV, Bolshak AA, Boukarim VZ. [Triangular plasty of left atrium in correction of mitral failure]. Klinicheskaia Khirurgiia. 2021;88(3-4):3-7. Russian. https://doi.org/10.26779/2522-1396.2021.3-4.03
- 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
- Abd Elaziz ME, Ibrahim IM. Reversal of Left Ventricular Functions in Chronic Mitral Regurgitation after Mitral Valve Replacement. Heart Surg Forum. 2016;19(4):E160-4. https://doi.org/10.1532/hsf.1440
- Chen L, Chen B, Hao J, Wang X, Ma R, Cheng W, et al. Complete preservation of the mitral valve apparatus during mitral valve replacement for rheumatic mitral regurgitation in patients with an enlarged left ventricular chamber. Heart Surg Forum. 2013;16(3):E137-43. https://doi.org/10.1532/HSF98.20121128
- Guo Y, He S, Wang T, Chen Z, Shu Y. Comparison of modified total leaflet preservation, posterior leaflet preservation, and no leaflet preservation techniques in mitral valve replacement – a retrospective study. J Cardiothorac Surg. 2019;14(1):102. https://doi.org/10.1186/s13019-019-0918-7
