Limitations of Indication for Left Atrial Plication
Journal Title: Journal of Medical Science And clinical Research - Year 2018, Vol 6, Issue 3
Abstract
Introduction: Patients with Rheumatic mitral valve disease with mitral stenosis, mitral regurgitation, or a combination of both can have enlargement of the left atrium (LA) with atrial fibrillation, hemodynamic complications and even atrial thrombus formation in LA. Currently, there is no consensus regarding the management of dilated LA based on its size. Materials and Methods: Patients who met Piccoli criteria, that is anteroposterior diameter of left atrium of over 65 mm on echocardiography with mitral valve disease of rheumatic etiology were divided into 2 groups prospectively : 37 patients underwent LA plication (group 1) and 46 patients without LA plication (group 2). Pre operative and postoperative functional and hemodynamic parameters data was collected of both the groups. Mean follow-up period was 10.33 months. Mean left atrial diameter was 8.77 +/- 1.62 cms preoperatively and 6.05 +/- 1.21 cm postoperatively in group 1. In group 2, the mean values were 7.88 +/- 0.81 and 6.28 +/- 1.14 cms respectively. Postoperatively patients were followed up with echocardiography and ECG to see for conversion to sinus rhythm Results: Postoperatively no differences were observed in ejection fraction and left ventricular end-diastolic diameter between the 2 groups. The postoperative decreases in pulmonary arterial pressure and the left atrial plication were not significantly different. Aortic cross clamp time was significantly less in group 2. In group 1, 23 patients with LA size > 8 cms were in AF preoperatively of which 20 patients attained sinus rhythm. In group 2, 22 patients with LA size > 8 cms were in AF preoperatively of which 8 patients attained sinus rhythm (p <0.05), where as 8 patients out of 11 patients in group 2 with LA size of <8 cms attained normal sinus rhythm. In group 1, 30 patients with preoperatively LA size > 8 cms, 25 patients attained LA size <6.5 cms. In group 2, 22 patients with preoperatively LA size > 8 cms, 8 patients attained LA size <6.5 cms (p<0.05). There is no added advantage of left atrial plication if the left atrial diameter is below 8 cms
Authors and Affiliations
Dr Girish Gowda S L
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