The new assessment of left atrial plication for giant left atrium.
OBJECTIVE
Left atrial plication is occasionally performed to reduce the size of the left atrium. We present our new method of evaluating the effect of plication on giant left atrium.


METHODS
Respiratory and cardiac function were evaluated before and after left atrial plication in 8 patients with giant left atrium. At the same time, the postoperative changes in the ratio of left atrial volume to left ventricular end-diastolic volume and left atrial volume to stroke volume were examined. These values were also compared with those of 5 patients who underwent individual mitral surgery and of 9 patients with normal cardiac function.


RESULTS
No significant change was seen in vital capacity, percent of one second forced expiratory volume, ejection fraction, pulmonary capillary wedge pressure and left ventricular end-diastolic volume index, while left atrial dimension and left atrial volume decreased significantly. Both the ratio of left atrial volume to left ventricular end-diastolic volume and the ratio of left atrial volume to stroke volume decreased after surgery; the significant difference disappeared compared to the normal values.


CONCLUSIONS
Left atrial plication is a useful method for patients with giant left atrium, since it corrects the disproportion between atrial and the ventricular volumes, which may decrease the left ventricular preload and increase the flow velocity passing through the mitral valve. The ratio of left atrial volume to left ventricular end-diastolic volume and to stroke volume are helpful for evaluating the efficacy of plication.
Daimon
M
M
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Kawada-cho, Shinjuku-ku, Tokyo, Japan. m-daimon@jg7.so-net.ne.jp
Nakano
H
H
D000368:Aged; D006348:Cardiac Surgical Procedures; D006332:Cardiomegaly / Q000503:physiopathology / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D005541:Forced Expiratory Volume; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014797:Vital Capacity