Circumferential left atrium resection for treating a giant left atrium.
BACKGROUND
An enlarged left atrium (LA) is a major risk factor for atrial fibrillation (AF) recurrence after a maze operation.


METHODS
Between 2000 and 2009, 35 patients underwent circumferential left atrium resection (CLAR), during mitral valve surgery. All patients had continuous AF.


RESULTS
Hospital mortalities occurred in two patients (5.7%). Postoperative bleeding occurred in two patients (5.7%). The average follow-up was 64 months. The mean New York Heart Association (NYHA) functional class had significantly decreased to 1.16 ± 0.37 from 2.77 ± 0.65 (p < 0.01). The mean LA dimension and the cardiothoracic ratio had significantly decreased to 52.8 ± 7.9 mm, and 0.55 ± 0.06 from 72.6 ± 11.0 mm, and 0.66 ± 0.11, respectively (p < 0.01). The mean early postoperative LA volume had decreased to 178 ± 68 mL (102-343 mL) from 332 ± 133 mL (124-655 mL) (p < 0.001). These LA volume reductions had been maintained until the last echocardiogram, which was done at an average of 29 months. In patients who underwent the maze procedure, the rate of sinus rhythm restoration was 82.1%, 81.5%, and 74% at three to six months, one year, and the last visit, respectively.


CONCLUSIONS
CLAR significantly reduced the LA volume. CLAR had an additional beneficial effect with the maze procedure of a relative rate of sinus rhythm restoration. To clarify the role of CLAR in marked symptom improvements after mitral valve surgery in patients with a giant LA, well-designed comparative studies are required.
Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Daegu, South Korea.
Jae Hyun
JH
Kim
Chan-Young
CY
Na
Sook Jin
SJ
Lee
Sam Sae
SS
Oh
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality / Q000601:surgery; D006332:Cardiomegaly / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography