Extensive Left Atrial Resection and Double Valve Repair for a Patient with Atrial Functional Mitral Regurgitation Associated Giant Left Atrium

Takahito Itoh＊	Kanako Kobayashi＊	Yujiro Kawai＊
Satoshi Ohtsubo＊

(Department of Cardiovascular Surgery, Tokyo Saiseikai Central Hospital＊, Tokyo, Japan)

A 72-year-old woman who had undergone three atrial catheter ablations for chronic atrial fibrillation was referred for surgical treatment for severe atrial functional mitral regurgitation. She suffered not only dyspnea but also dysphagia due to esophagus compression by a giant left atrium 15×12×11 centimeters in size. In her surgery, mitral valve repair using a 36-millimeter artificial ring, tricuspid annuloplasty and resection of the left atrial appendage were performed. In addition, the posterior, lateral, and superior wall of left atrium, 4 centimeters in width, was extensively resected to reduce left atrial volume. Postoperative echocardiography showed a decrease in both mitral and tricuspid regurgitation to trivial levels as well as an improvement in left ventricular diastolic function. Postoperatively her dysphagia disappeared and NYHA class improved from III to I. In her chest X ray, the cardiothoracic ratio fell from 80% to 56%, and the tracheal bifurcation angle decreased from 110 to 90 degrees. In a patient with a giant left atrium due to atrial functional mitral regurgitation, a favorable clinical outcome resulted from double valve repair combined with extensive left atrial resection.

 

Jpn. J. Cardiovasc. Surg. 51: 285-290 （2022）

Keywords：left atrium resection; giant left atrium; atrial functional mitral regurgitation; spiral resection; left ventricular diastolic dysfunction