Ersin SARIÇAM, Neyyir Tuncay EREN, Gökhan ÖZERDEM, Barış UYMAZ, Başar CANDEMİR

Left atrial reduction by posterior wall plication combined with mitral valve surgery in patients with a dilated left atrium

Amaç: Sol atrial genişlemenin posteriyor plikasyon yöntemiyle azaltılması ile atriyal fibrilasyon ve tromboembolik olayların engellenmesi amaçlandı. Çalışma planı: Mayıs 2003 ile Ocak 2009 tarihleri arasında 38 hastaya (17 erkek, 21 kadın; ort. yaş 53.7±9.9 yıl; dağılım 44-76 yıl) posteriyor duvar plikasyonu ile sol atriyal küçültmeli mitral kapak cerrahisi ameliyatı uygulandı. Bu çalışmada kronik atriyal fibrilasyon (AF) için ne bipolar ne de unipolar kateter ablasyonu tedavisi uygulandı. Ayrıca kronik AF için radyofrekans ablasyonu uygulanan hastalar çalışmaya dahil edilmedi. Bulgular: Taburcu olduklarında hastaların 15’i (%39) sinüs ritmindeydi. Takip sırasında sinüs ritmi 14 hastada (%37) geri döndü. Sol atriyumun ameliyat öncesi çapı, ameliyat sonrası 6. ayda 7.0±1.4 cm’den 4.6±0.5 cm’ye anlamlı ölçüde azalmıştı. Sonuç: Sol atriyum boyut küçültülmesi basittir, az zaman alır, aynı zamanda sinüs ritminin korunmasında etkindir ve tek başına mitral kapak cerrahisi ile karşılaştırıldığında herhangi bir ek mortalite ve morbiditeye neden olmaz.

Dilate sol atriyumlu hastalarda mitral kapak cerrahisi ile birlikte posteriyor duvar plikasyonu ile sol atriyal küçültme

Background: We aimed to reduce atrial fibrillation and thromboembolic events by reducing left atrial dilatation via posterior plication technique. Methods: B etween M ay 2 003 a nd J anuary 2 009, 3 8 patients (17 males, 21 females; mean age 53.7±9.9 years; range 44 to 76 years) underwent mitral valve surgery with left atrial reduction by posterior wall plication. Neither bipolar nor unipolar catheter ablation therapy for chronic atrial fibrillation (AF) was performed in this study. We also did not include patients in this study who had undergone radiofrequency ablation therapy for chronic AF. Results: At discharge, 15 patients (39%) were in sinus rhythm. During follow-up, sinus rhythm was restored in 14 patients (37%). Left atrium diameter was significantly reduced from 7.0±1.4 cm preoperatively to 4.6±0.5 cm at six months after surgery. Conclusion: In conclusion, left atrial size reduction is simple, takes less time, and is also effective in maintaining sinus rhythm without adding any additional mortality or morbidity compared to mitral valve surgery alone.

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