DOI: http://dx.doi.org/10.18203/2349-2902.isj20210082

A study to assess the impact of left atrial size reduction in outcome of the patients undergoing mitral valve surgery for mitral valve disease with left atrial enlargement in a tertiary care hospital

Raghavendra K. H., Chandra A.

Abstract


Background: Rheumatic mitral valve disease (mitral stenosis or regurgitation) remains the common heart disease in developing countries. Mitral valve is involved in 99% of cases. The prognostic implication of LA (left atrium) size has also been shown in high-risk subgroups, such as patients with acute myocardial infarction, atrial arrhythmia, LV dysfunction, or dilated cardiomyopathy, and patients undergoing valve replacement for aortic stenosis and mitral regurgitations. Objective of the study was to study the impact of left atrial size reduction in patients undergoing mitral valve surgery for mitral valve disease with left atrial enlargement on clinical outcome and echocardiographic parameters.

Methods: A prospective study was done at department of cardiovascular and thoracic surgery, Sri Venkateshwara institute of medical sciences, Tirupati from June 2012 and June 2013.The study population consisted of patients with rheumatic mitral valve disease with or without tricuspid valve disease with left atrial size enlargement who underwent mitral valve surgery alone and mitral valve surgery with left atrial reduction. Twenty consecutive subjects were taken in each group during the study period. 

Results: The age range is 21 to 61 years. There means age is 39.7±10.3 years. in the study group. Following MVR significant improvement in the NYHA (New York Heart Association) functional class was noted in all the patients. The decrease in RVSP, LA size, and TR was noted in all the patients.

Conclusions: It seems reasonable to suggest that patients who undergo LA reduction along with MVR have significant improvement in clinical outcome and NYHA functional class with less thromboembolic complications during long term follow up.


Keywords


Mitral valve, Rheumatic fever, NYHA left atrium, Sinus rhythm

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References


Padmavathi S. Epidemiology of cardiovascular disease in India. I. Rheumatic heart disease. Circulation. 1962;25:703-10.

Wood P. An appreciation of mitral stenosis. I. Clinical features. Br Med J. 1954;1:1051-63.

Seckeler MD, Hoke TR. The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol. 2011;3:67-84.

Shah B, Sharma M, Kumar R, Brahmadathan KN, Abraham VJ, Tandon R. Rheumatic heart disease: Progress and challenges in India. Indian J Pediatr. 2013;80:77-86.

Gross L, Friedberg CK. Lesions of the cardiac valves in rheumatic fever. Am J Pathol. 1936;12:855-910.

Rheumatic fever and rheumatic heart disease. World Health Organ Tech Rep Ser. 2004;923:1.

Serra JL, Bendersky M. Atrial fibrillation and renin–angiotensin system. Ther Adv Cardiovasc Dis. 2008;2:215-23.

Potter LR, Yoder AR, Flora DR, Antos LK, Dickey DM. Natriuretic peptides: their structures, receptors, physiologic functions and therapeutic applications. Handb Exp Pharmacol. 2009;191:341-66.

Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol. 2006;47:2357-63.

Stefanadis C, Dernellis J, Toutouzas P. A clinical appraisal of left atrial function. Eur Heart J. 2001;22:22-36.

Read D, Abbott R, Smucker M. Prediction of outcome after mitral valve replacement in patients with symptomatic mitral regurgitation. The importance of left atrial size. Circulation 1991;84:23-34.

Benjamin E, D’Agostino R, Belanger A, Wolf PA, Levy D. LA size and the risk of stroke and death: The Framingham Heart Study. Circulation. 1995;92:835-41.

Cox JL, Boineau JP, Schuessler RB, Kater KM, Lappas DG. Five-year experience with the maze procedure for atrial fibrillation. Ann Thorac Surg. 1993;56:814-23.

Blume GG, Mcleod CJ, Barnes ME, Seward JB, Pellikka PA, Bastiansen PM et al. Left atrial function: physiology, assessment, and clinical implications. Eur J Echocardiogr. 2011;12:421-30.

Defauw JJ, Guiraudon GM, Van Hemel NM, Vermeulen FE, Kingma JH, De Bakker JM. Surgical therapy of paroxysmal atrial fibrillation with the "corridor" operation. Ann Thorac Surg. 1992;53:564-70.

Topal AE, Eren MN, Celik Y. Left ventricle and left atrium remodeling after mitral valve replacement in case of mixed mitral valve disease of rheumatic origin. J Card Surg. 2010;25:367-72.

Scherer M, Dzemali O, Aybec T, Wimmer-Greinecker G, Moritz A. Impact of left atrial size on chronic atrial fibrillation in mitral valve surgery. J Heart Valve Dis. 2003;12:469-74.

Ozerdem G, Uymaz B, Sancam E, Candemir B, Eren NT. Left atrial reduction by posterial wall placation combined with mitral valve surgery in patients with a dilated left atrium. Türk Göğüs Kalp Damar Cer Derg. 2011;19:311-6.

Kutay V, Kirali K, Ekim H, Yakut C. Effects of left giant atrium on thromboembolism after mitral valve replacement. Asian Cardiovasc Thorac Ann. 2005;13:107-11.

Erdogan H, Kirali K, Omeroglu S, Goksedef D, Isik O, Yakut C. Partial cardiac autotransplantation for reduction of the left atrium. Asian Cardiovasc Thorac Ann. 2004;12:111-4.

Scherer M, Dzemali O, Aybek T, Wimmer-Greinecker G, Moritz A. Impact of left atrial size reduction on chronic atrial fibrillation in mitral valve surgery. J Heart Valve Dis. 2003;12:469-74.

Marui A, Nishina T, Tambara K, Saji Y, Shimamoto T, Nishioka M et al. A novel atrial volume reduction technique to enhance the Cox maze procedure: initial results. J Thorac Cardiovasc Surg. 2006;132:1047-53.

Johnson J, Danielson GK, MacVaugh H 3rd, Joyner CR. Plication of the giant left atrium at operation for severe mitral regurgitation. Surgery. 1967;61:118-21.

Tonguç E, Kestelli M, Özsöyler I, Yılik L, Yilmaz A, Özbek C et al. Limit of indication for plication of giant left atrium. Asian Cardiovasc Thorac Ann. 2001;9:24-6.

Pande S, Agarwal SK, Mohanty S, Bansal A. Effect of mitral valve replacement on reduction of left atrial size. Asian Cardiovasc Thorac Ann. 2013;21:288-92.