Symptomatic pulmonary hypertension with giant left atrial v waves after surgical maze procedures: evaluation by comprehensive hemodynamic catheterization.
BACKGROUND
The surgical maze procedure is highly effective in treating symptomatic atrial fibrillation but may have detrimental effects on left atrial (LA) contractile function and compliance.


OBJECTIVE
To describe a series of patients presenting with symptomatic pulmonary hypertension due in part to LA dysfunction after surgical maze procedures.


METHODS
This report includes 9 patients who (1) presented to Mayo Clinic (Rochester, MN) between 2008 and 2012 with unexplained dyspnea and pulmonary hypertension after the surgical maze procedure, (2) underwent comprehensive hemodynamic catheterization with transseptal measurement of LA pressure, (3) had large v waves on LA pressure waveforms, and (4) did not have significant mitral valve regurgitation or stenosis or pulmonary vein stenosis.


RESULTS
Invasive hemodynamic assessment revealed (1) severe pulmonary hypertension (mean pulmonary pressure 47 ± 6 mm Hg), (2) severe LA hypertension (27 ± 4 mm Hg), (3) giant LA v waves (to 50 ± 8 mm Hg), (4) absence of LA or left ventricular a waves, and (5) blunted x descents (2 ± 1 mm Hg). Left ventricular end-diastolic pressure was also elevated (20 ± 5 mm Hg).


CONCLUSIONS
Abnormalities in LA compliance and contractility may lead to giant LA v waves and symptomatic pulmonary hypertension after surgical maze procedures. This syndrome should be considered in the differential diagnosis for pulmonary hypertension and underscores the importance of comprehensive hemodynamic catheterization.
Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: Terrence.D.Welch@Hitchcock.org.
Terrence D
TD
Welch
Megan
M
Coylewright
Brian D
BD
Powell
Samuel J
SJ
Asirvatham
Bernard J
BJ
Gersh
Joseph A
JA
Dearani
Rick A
RA
Nishimura
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left / Q000502:physiology*; D062185:Atrial Pressure / Q000502:physiology*; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D009200:Myocardial Contraction; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies
AF; Ablation; Atrial fibrillation; Heart failure; Hemodynamics; LA; LV; Left atrial function; NYHA; New York Heart Association; PHTN; Pulmonary hypertension; RF; atrial fibrillation; left atrial/atrium; left ventricular; pulmonary hypertension; radiofrequency