title: Improved left atrial transport and function with orthotopic heart transplantation by bicaval and pulmonary venous anastomoses.
abstract: Orthotopic heart transplantation (OHT) with bicaval and pulmonary venous anastomoses avoids the large atrial anastomoses of the standard biatrial technique. To determine whether the bicaval technique improves atrial performance, we used Doppler echocardiography to study 13 patients with bicaval OHT, 15 with biatrial OHT, and 8 normal subjects. All were in sinus rhythm and free of rejection. Left atrial size, transmitral (M) and late diastolic (A) mitral flow velocity integrals were measured. Atrial transport (A/M, %) and atrial ejection force (kilodynes, calculated from peak A-wave velocity and mitral orifice area) were assessed. Left atrial dimensions in the bicaval (4.3 +/- 0.5 cm) and biatrial groups (4.9 +/- 0.9 cm) were larger than in controls (3.3 +/- 0.8 cm, p < 0.05). Left atrial transport (37% +/- 12% and 35% +/- 12%) and ejection force (14.1 +/- 6.9 kdyne and 10.2 +/- 7.8 kdyne) were similar in the bicaval group and controls (p not significant) but were significantly lower in the biatrial group (20% +/- 19% and 3.6 +/- 4.0 kdynes, p < 0.05). The bicaval and pulmonary venous technique of OHT produces more physiologic atrial function compared with the biatrial technique as evidenced by greater atrial ejection force and more normal atrial transport.
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048-1865, USA.
authors.forename: D
authors.initials: D
authors.lastname: Freimark
authors.forename: L S
authors.initials: LS
authors.lastname: Czer
authors.forename: I
authors.initials: I
authors.lastname: Aleksic
authors.forename: C
authors.initials: C
authors.lastname: Barthold
authors.forename: D
authors.initials: D
authors.lastname: Admon
authors.forename: A
authors.initials: A
authors.lastname: Trento
authors.forename: C
authors.initials: C
authors.lastname: Blanche
authors.forename: M
authors.initials: M
authors.lastname: Valenza
authors.forename: R J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D016279:Atrial Function, Left; D015150:Echocardiography, Doppler / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D016027:Heart Transplantation / Q000379:methods* / Q000502:physiology* / Q000706:statistics & numerical data; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011667:Pulmonary Veins / Q000601:surgery*; D014683:Vena Cava, Superior / Q000601:surgery*