Surgical correction and postoperative period management of a patient with the giant left atrium: case report

Yakov Maul 1, Aidyn Kuanyshbek 2, Ivan Vakhrushev 2, Tatyana Li 2 *
More Detail
1 Cardiac Surgery Department, National Research Cardiac Surgery Center, Astana, Kazakhstan
2 Intensive Care Unit, National Research Cardiac Surgery Center, Astana, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 19, Issue 6, pp. 104-107. https://doi.org/10.23950/jcmk/12696
OPEN ACCESS 854 Views 674 Downloads
Download Full Text (PDF)

ABSTRACT

This case report describes the history of a 62-year-old man with symptoms of severe heart failure caused by critical mitral valve (MV)  stenosis with extremely enlarged left atrium (LA) and chronic rheumatic heart disease. The patient has had MV replacement, aortic valve (AoV) replacement, tricuspid valve (TV) plastic surgery, left atrial thrombectomy, reduction, and resection of the LA.
The operation was performed by median sternotomy, in condition of artificial blood circulation with aortic cannulation, separate cannulation of Cava veins and hypothermia up to 29 C. Selective antegrade cold blood cardioplegia was used for the myocardium protection.
Revision of the MV was performed via the right atrium. Findings: the valves deformed by severe fibrosis, thickened subvalvular structures. Also, there was a massive thrombosis of the LA cavity. A thrombectomy was performed, total amount of evacuated thrombotic masses - 350 ml. Considering the circumstances of atriomegalia, was decided to provide reduction of the LA. MV replacement with mechanical prosthesis SJM MastersSeries # 31, aortic valve replacement with prosthesis SJM MastersSeries #25, and Suture commissuroannuloplasty were performed.
We believe that our surgical tactics has effectively reduced the size of the LA, together with the correction of valvular malformation, can significantly improve the patient's life quality.
Keywords: mitral valve replacement, aortic valve replacement, thrombectomy, valvular malformation, resection of the left atrium

CITATION

Maul Y, Kuanyshbek A, Vakhrushev I, Li T. Surgical correction and postoperative period management of a patient with the giant left atrium: case report. J CLIN MED KAZ. 2022;19(6):104-7. https://doi.org/10.23950/jcmk/12696

REFERENCES

  • Authors/Task Force Members, et al. Guidelines on the management of valvular heart disease (version 2012) The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European heart journal. 2012;33(19):2451-2496. https://doi.org/10.1093/eurheartj/ehs109
  • Nishimura, Rick A., et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2017; 70(2):252-289. https://doi.org/10.1161/CIR.0000000000000503
  • Vassileva, Christina & Boley, Theresa & Markwell, Stephen & Hazelrigg, Stephen. Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery. 2011; 39:295-303. https://doi.org/10.1016/j.ejcts.2010.06.034
  • Apostolakis, Efstratios, and Jeffrey H. Shuhaiber. The surgical management of giant left atrium. European journal of cardio-thoracic surgery. 2008; 33(2):182-190. https://doi.org/10.1016/j.ejcts.2007.11.003
  • Di Eusanio G., Gregorini R., Mazzola A., Clementi G., Procaccini B., Cavarra F., Taraschi F., Esposito G., Di Nardo W., Di Luzio V. Giant left atrium and mitral valve replacement: risk factor analysis. Eur J Cardiothorac Surg. 1988; 2:151-159. https://doi.org/10.1016/1010-7940(88)90063-2
  • Kojuharov X., Khadzhipetrov N. Clinical and echocardiographic assessment of the "giant" left atrium. Cardiology. 1996; 9: 64-66. https://doi.org/10.4103/1995-705X.99227
  • El Maghraby, Ahmed, and Rachel Hajar. Giant left atrium: a review. Heart views: the official journal of the Gulf Heart Association. 2012; 13(2):46. https://doi.org/10.4103/1995-705X.99227
  • Riccardo Sinatra, Ivana Pulitani, Andrea Antonazzo, Giovanni Melina. A novel technique for giant left atrium reduction. European journal of cardio-thoracic surgery. 2001; 20(2):412-414. https://doi.org/10.1016/S1010-7940(01)00802-8
  • Sugiki, Hiroshi, et al. Novel technique for volume reduction of giant left atrium: simple and effective “spiral resection” method. The Annals of thoracic surgery. 2001; 81(1):378-380. https://doi.org/10.1016/j.athoracsur.2004.10.022
  • Reed D, Abbott RD, Smucker ML, Kaul S. Prediction of outcome after mitral valve replacement in patients with symptomatic chronic mitral regurgitation. The importance of left atrial size. Circulation 1991; 84:23–34. https://doi.org/10.1161/01.CIR.84.1.23
  • Kawazoe K, Beppu S, Takahara Y, Nakajima N, Tanaka K, et al. Surgical treatment of giant left atrium combined with mitral valvular disease. Plication procedure for reduction of compression to the left ventricle, bronchus, and pulmonary parenchyma. J Thorac Cardiovasc Surg. 1983; 85:885–92. https://doi.org/10.1016/S0022-5223(19)37479-3
  • Kachel E., Schaff H.V., Moussa F., Preisman S., Ranani E., Sternik L. Giant left atrium needed negative pressure ventilation. Ann. Thorac. Surg. 2010; 89:269-271. https://doi.org/10.1016/j.athoracsur.2009.03.102
  • Babak Sabet Modaress Hospital, Sadat abad. Asymptomatic Giant Left Atrium: Do Atrial Size Changes After Successful Valve Replacement? 7-Years Follow-up Case. Acad J Surg. 2016; 3:1-2.
  • Welch, T. D., Coylewright, M., Powell, B. D., Asirvatham, S. J., Gersh, B. J., Dearani, J. A., & Nishimura, R. A. Symptomatic pulmonary hypertension with giant left atrial v waves after surgical maze procedures: evaluation by comprehensive hemodynamic catheterization. Heart Rhythm. 2013; 10(12):1839-1842. https://doi.org/10.1016/j.hrthm.2013.09.010
  • Darwazah, A.K., El Sayed, H. Giant left atrium associated with massive thrombus formation. Thrombosis Journal. 2013; 11(1):1-5. https://doi.org/10.1186/1477-9560-11-5