Left Atrial Plication and Mitral Valve Replacement for Giant Left Atrium Accompanying Mitral Lesion

Abstract

Between January 1982 and November 1992, 38 patients received simultaneous mitral valve replacement (MVR) and left atrial plication (LAP) because of giant left atrium accompanying mitral lesion. Their ages ranged from 33 to 70 years, and the mitral lesion was caused by rheumatic heart disease in all patients. MVR was performed with a St. Jude Medical prosthesis for all patients and the left atrial wall was plicated with running 3-0 Nespolene to reduce the width to 3 to 5 cm. Respiration requiring mechanical ventilation more than 48 hours after operation occurred in four patients (10.5%) and postoperative low cardiac output requiring a high dose of dopamine HCl or intraaortic balloon pumping in nine patients (23.7%). The left atrial diameter measured by echocardiogram was a mean of 7.3 +/- 1.0 cm before operation and 5.8 +/- 1.0 cm postoperatively. The cardiothoracic ratio on the chest roentgenogram registered a preoperative mean of 73.3% +/- 9.8% and was 65.7% +/- 8.4% after operation. The pre- and postoperative values were significantly different (p < 0.01). The postoperative exercise level was a mean of 5.3 metabolic units for 24 patients and the postoperative New York Heart Association functional classification indicated Class I or II for 37 patients with no evidence of left atrial thrombus except in the case of one early death. LAP with MVR for patients with giant left atrium due to mitral lesion appeared to result in improvement in respiratory and circulatory functions.

Effects of Giant Left Atrium on Thromboembolism after Mitral Valve Replacement

“…3 Several techniques of LA size reduction combined with mitral valve replacement (MVR) have been reported for the elimination of LA compression symptoms and postoperative complications. [4][5][6][7][8] In the present report, LA reduction procedures were not applied in patients with LA size over 6.5 cm. The aim of this study was to compare the thromboembolic complication rates at postoperative follow-up in patients with and without GLA who underwent MVR.…”

Isolated Rheumatic Mitral Regurgitation with Giant Left Atrium in Sinus Rhythm – A Case Report

“…Giant left atrium has been ascribed to left atrial enlargement >6 cm in diameter 5 . Left atrial dilatation occurs due to various causes such as mitral valve disease, left ventricular systolic as well as diastolic dysfunction and others.…”

Giant left atrium with spontaneous echo contrast: a harbinger of thromboembolic phenomenon

“…Postmitral valve replacement, the echocardiogram revealed the regression of LA size and disappearance of the SEC (figure 3). According to Isomura et al ,1 the giant LA is defined as diameter more than 8 cm. The SEC is an echogenic swirling pattern of blood flow, caused by an increased ultrasonic backscatter from the aggregation of the cellular components of blood in the conditions of blood stasis or low-velocity blood flow2 and has been associated with a higher risk of thromboembolism and cerebrovascular accident 3…”