Atrial Plication with Appendage Obliteration during MVR, in Huge Left atrium, Early Outcome
Objective: To evaluate the effects of new combined technique of posterior left atrial plication and obliteration of left and right auricles, during mitral valve replacement in rheumatic patients with huge left atrium.
Methods: Twenty six rheumatic mitral patients with giant left atrium (>6.5 cm), were separated prospectively into 2 groups. Group A: 12 patients with left atrial compression symptoms who received
posterior left atrial plication with obliteration of left and right auricles during MVR. Group B: 14 patients without compression symptoms who operated on without plication. We compared the outcome of the groups to investigate the effect of this technique.
Results: No difference between the groups in preoperative clinical variables e.g. Age, sex, atrial fibrillation and ejection fraction. As regard operative, aortic clamping and cardiopulmonary times, there was no significant difference between the groups. At mean follow-up of 6.4 ± 1.2 months. Left atrial diameter significantly decreased in group A from 7.5 cm to 5.5 cm (p<0.01), it remained unchanged in group B. Postoperative ejection fraction (EF) in group A was better than preoperative EF and in comparison with group B. Sinus rhythm was restored in 6 patients (50%) in Group A with no restoration in group B.
Conclusions: In rheumatic patients with left atrium dimension >6.5 cm, posterior left atrial wall plication with obliteration of left and right auricles during mitral valve replacement, appears to be safe and effective. It reduces left atrial dimension and incidence of atrial fibrillation. Also, it improves postoperative cardiac functions.