Triangular plasty of left atrium in a left-sided atriomegaly
Objective. Studying possibilities of the triangular plasty of left atrium procedure, performed while prosthesis of a mitral valve.
Materials and metods. Into the main group 137 patients, suffering isolated mitral failure, complicated by left atriomegaly (diameter of left atrium ≥ 6.0 cм), to whom surgical treatment was performed in Amosov National Institute of Cardiovascular Surgery from 01.10.2010 to 01.01.2019 yr, were included. In all the patients a prosthesis of a mitral valve, preserving native structures of a mitral valve with reduction of the left atrium cavity, using procedure of the left atrium triangular plasty, was performed. Into a control group were included 57 patients, in whom a mitral valve correction without a left atrium reduction was performed only for a mitral valve failure and a left-sided atriomegaly (diameter of left atrium was ≥ 6.0 cm).
Results. Of 137 patients of the main group on the hospital stage 3 (2.2%) have died. Dynamics of echocardiographic indices of the left atrium diameter on different stages was following: (65.5 ± 3.8) mm preoperatively, (51.5 ± 2.1) mm postoperatively, (52.5 ± 2.2) mm in a remote follow-up period, in a remote follow-up period in (5.1 ± 0.4) years at average, thromboembolic complications (the transient disorders of the brain blood circulation) were noted in (1.6%) of 125 patients.
Of 57 patients of a control group on the hospital stage 2 (3.5%) have died. Dynamics of echocardiographic indices, concerning diameter of the left atrium on various stages was following: (66.7 ± 2.7) mm preoperatively, (63.5 ± 2.3) mm postoperatively, (71.5 ± 2.4) mm in the remote follow-up period. In the remote follow-up period in (7.1 ± 0.4) years, thromboembolic complications were noted in 7 (14.6%) of 48 patients.
Conclusion. The procedure of triangular plasty of left atrium constitutes an obligatory stage while performing correction of a mitral failure in presence of a left-sided atriomegaly (diameter of left atrium ≥ 6.0 cm). The procedure is miniinvasive and effective, leads to significant improvement of the left atrium morphometry and is accompanied by low risk of the complications occurrence and hospital mortality. The data accumulated and estimation of remote results of the procedure permits her to occupy a significant place among other methods of atrioplasty.
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: a report of the 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) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2006;48(3):e1-148. doi: 10.1016/j.jacc.2006.05.021. Erratum in: J Am Coll Cardiol. 2007 Mar 6;49(9):1014. PMID: 16875962.
Knyshov GV, Bendet YaA. Acquired heart defects. Kiev; 1997. 279 p. ISBN 966-7084-04-3. [In Russian].
La Meir M. Surgical options for treatment of atrial fibrillation. Ann Cardiothorac Surg. 2014;3(1):30-7. doi: 10.3978/j.issn.2225-319X.2014.01.07. PMID: 24516795; PMCID: PMC3904328.
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 Sep-Oct;58(2):152-67. doi: 10.1016/j.pcad.2015.08.004. Epub 2015 Aug 4. PMID: 26247494.
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. doi: 10.1002/ccd.26170. Epub 2015 Sep 21. PMID: 26256562.
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. doi: 10.1016/j.jacc.2014.03.022. Epub 2014 Mar 28. Erratum in: J Am Coll Cardiol. 2014 Dec 2;64(21):2305-7. PMID: 24685669.
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. [In Russian].
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. doi: 10.1016.j.Pcad.2015.08.006. [In Russian].
Popov VV, Pukas EV. Mitral valve surgery with left atrial plasty on atriomegaly. Ukrainian Journal of Cardiology. 2018;(Suppl 1):132. doi: 11.1122/jacc.2018.04.11. [In Russian].
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. doi: 10.2123/jacc.2017.01.22. [In Ukrainian].
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