Left atrial reduction for chronic atrial fibrillation associated with mitral valve disease

Sankar, Nainar Madhu; Farnsworth, Alan

doi:10.1016/s0003-4975(98)00281-1

Cited by 32 publications

(19 citation statements)

References 7 publications

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“…Biplane two-dimensional echo is accurate for determining left atrial size9 but is not widely available or affordable. Chest radiographs are often used to estimate left atrial size, being cheaper and more readily available, and clinical decisions are often based on this without regard to the accuracy and precision of this measurement.…”

Section: Discussionmentioning

confidence: 99%

The reliability of chest radiographs in predicting left atrial enlargement

Quinton¹,

Ker²,

Rheeder³

et al. 2010

CardioVascular Journal of Africa

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IntroductionEstimates of left atrial size in patients with suspected cardiac disease play an important role in predicting prognosis and events, as well as treatment decisions. Two methods are commonly used to estimate left atrial size: chest radiography and cardiac ultrasound. This study aims to determine the test characteristics by comparing the use of radiographs to cardiac ultrasound (the gold-standard test).MethodsData from patients older than 18 years admitted to Steve Biko Academic Hospital during 2000–2003 who had both chest radiographs and cardiac ultrasound were included in this cross-sectional, retrospective analysis. Chest radiographs were classified into three quality classes, and the sub-carinal angle (SCA) and sub-angle distance (SAD) were measured twice in all available radiographs by two observers. Intra- and inter-observer variability (three methods) as well as the predictive value of the carinal angle and sub-angle distance measurements were determined using logistic regression (with left atrial enlargement – determined by ultrasound as comparator).ResultsData for 159 patients were available (154 cardiac ultrasounds and 178 chest radiographs). Intra-observer variability for chest radiograph measurements was low with almost perfect concordance (p = 0.000). Inter-observer variability was higher for supine radiographs. Using logistic regression, a linear model was identified which was statistically significant only for erect radiographs. While goodness-of-fit analysis showed that the model fits the data, performance characteristics were poor, with high sensitivity and low specificity, and an area under the ROC curve of 0.62–0.63, depending on type of radiograph and measurement (SCA or SAD). Linearity in the logit of the dependent variable was assessed, and found to be present at the extremes of SCA measurements for the supine radiograph data and in the first three quartiles for erect radiograph data. A non-linear model determined by fractional polynomial analysis did not perform significantly better than the original linear model. Cut-off values for the SCA of 72° and 84° (erect and supine radiographs, respectively) were found to give the best compromise between sensitivity and specificity. The corresponding cut-off values for SAD were 24.1 and 26.9 mm.ConclusionAssessment of either SCA or SAD to determine left atrial size was equivalent and repeatable, both with the same observer and between two observers (less so for supine radiographs). While this measure was precise, it was found not to be very accurate. Therefore, chest radiographs are not reliable in predicting left atrial enlargement.

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Section: Discussionmentioning

confidence: 99%

The reliability of chest radiographs in predicting left atrial enlargement

Quinton¹,

Ker²,

Rheeder³

et al. 2010

CardioVascular Journal of Africa

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“…Asimismo, aurículas de gran tamaño (más de 45 mm 42 ) pueden ser causantes del inicio de FA en pacientes en RS 18 . Por estos motivos, se recomienda la reducción de la AI mediante la excisión de su tercio medio en pacientes sometidos a cirugía de la válvula mitral que se encuentran en FA 23 .…”

Section: Procedimientos Asociados a La Cirugía De La Ablaciónunclassified

“…Años después se describe la técnica The corridor (pasillo), en el que se aislaba una banda de miocardio entre el NS y el NAV 21 . A pesar de que un 69% no presentaban arritmias auriculares después del procedimiento 22 , las aurículas permanecían en FA o sin contracción (perjudicando el llenado del ventrículo izquierdo) 23 , y hasta un 16% de los pacientes necesitaban colocar marcapasos (MP) permantente. Por otro lado, debido al riesgo de tromboembolismo, permanecía la necesidad de ACO 22 .…”

Section: Introductionunclassified

“…Además el 97% los pacientes estaban libres de presentar ACVA a los cinco años, con resultados significativamente mejores en aquellos a los que exclusivamente se les realizaba sustitución o reparación de la válvula mitral 28 . Pero, por otro lado, en grandes series publicadas, los resultados no eran tan buenos (en pacientes con enfermedad valvular los resultados rondaban el 70-80%) 29 y la complejidad de la técnica comenzaba a hacerse patente 25,26 : hasta un 40% necesitaban de MP permanente 23 , y las complicaciones hemorrágicas en el post-operatorio inmediato eran una constante.…”

Section: Introductionunclassified

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Cirugía de la fibrilación auricular

Hernández-Estefanı́a

Martín-Trenor²,

Praschker

et al. 2011

Anales Sis San Navarra

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“…The middle third of the LA, including the LA appendage, was excised, as followed by a report by Sankar and Farnsworth. 1 The mitral valve was found to have developed fibrosis of the leaflet, and chordae shortening without calcification. There was a tear measuring 2 cm on the anterior leaflet, which was created by the percutaneous mitral comissurotomy.…”

Section: Case Reportmentioning

confidence: 99%

Repair of Left Ventricular Rupture Following Mitral Valve Replacement Concomitant With Left Atrial Reduction Procedure

et al. 2001

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eft ventricular (LV) rupture is one of the most severe complications after mitral valve replacement (MVR). Although its occurrence is rare, it is potentially lethal. The present report describes successful repair of a type 1 LV rupture, which occurred after MVR concomitant with a left atrial (LA) reduction procedure, by combination of an intracardiac patch repair and an extracardiac buttress suture. Case ReportA 64-year-old woman, who was diagnosed with mitral stenosis with atrial fibrillation resulting from rheumatic fever, underwent percutaneous mitral comissurotomy. After this procedure, severe mitral regurgitation occurred. The patient subsequently underwent mitral replacement and LA reduction in May 1999.The operation was performed with a cardiopulmonary bypass and intermittent/continuous cold blood cardioplegia. The atrial incision was initiated from the right side of the LA, and an area of the pulmonary vein was circularly isolated. The middle third of the LA, including the LA appendage, was excised, as followed by a report by Sankar and Farnsworth. 1 The mitral valve was found to have developed fibrosis of the leaflet, and chordae shortening without calcification. There was a tear measuring 2 cm on the anterior leaflet, which was created by the percutaneous mitral comissurotomy. Both the anterior and the posterior leaflet were excised. The 27 mm ATS mitral prosthesis is fixed to the mitral annulas using interrupted mattress sutures. Japanese Circulation Journal Vol.65, June 2001After weaning from the cardiopulmonary bypass, a major bleeding was suddenly noted from the posterior area of the heart during the hemostasis of the LA suture line. Simultaneously, the ST level was elevated on the II and V5 leads of the electrocardiogram. Because LV rupture was suspected, cardiopulmonary bypass was re-established immediately. Epicardial oozing and myocardial hematoma were recognized at the posterior left ventricular wall, but the Rupture of the posterior wall of the left ventricle after mitral valve replacement is a dire complication associated with a very high mortality. This study reports a successful repair of type 1 left ventricular rupture, which occurred after mitral valve replacement concomitant with a left atrial reduction procedure, by combination of an intracardiac patch and an extracardiac buttress suture. In a case such as this, in which hemostasis is quite difficult to establish, this combination technique is particularly effective. ( Full-thickness buttressed suture was placed on the epicardium while making an effort to avoiding circumflex artery injury. Additionally, fibrin glue/sheet and GRF glue on the Teflon sheet were used to enhance hemostasis.

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Left atrial reduction for chronic atrial fibrillation associated with mitral valve disease

Cited by 32 publications

References 7 publications

The reliability of chest radiographs in predicting left atrial enlargement

The reliability of chest radiographs in predicting left atrial enlargement

Cirugía de la fibrilación auricular

Repair of Left Ventricular Rupture Following Mitral Valve Replacement Concomitant With Left Atrial Reduction Procedure

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