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The effects of left atrium plication on postoperative left ventricular and respiratory dysfunction, systemic embolization and hospital mortality of patients with chronic rheumatic mitral valvular disease with giant left atrium.

Author

Ma. Teresa  B. Abola,
Ramon F. Abarquez,
Manuel T. Chuachiaco,
Florante Tomacruz ,
Florante Lomibao,

Related Institution

Adult Cardiology - Philippine Heart Center

Publication Information

Publication Type
Research Project
Date
January 1-December 1, 1991

Abstract

Massive enlargement of the left atrium has long been known to develop in patients with long-standing severe mitral valvular disease. The reported incidence of giant left atrium (GLA) in patients with rheumatic heart disease (RHD) ranges from 0.3% - 12% based on local data (Noval, et al., 1988), about 40% of such patients have GLA. Two distinctive pathophysiological changes associated with this complication have been observed. One is respiratory dysfunction produced by the, compression of the left main bronchus and/or the right middle and lower lobes. The other is hemodynamic disturbance produced by the compression of the posterobasal portion of the left ventricular wall. Surgical reduction in its size has been recommended since the early days of cardiac surgery as introduced by Johnson and associates, and of LeRoux et al. but has not been generally adopted. Kawazoe and colleagues have used a special plication procedure designed to reduced bronchial compression and improve left ventricular performance. Their experience suggests that it is effective in doing this. In our setting, it remains controversial as to whether it needs to be adopted.


Postoperatively, systemic embolization has been reported to occur almost with the same frequency as the above mentioned hemodynamic and respiratory complications. And yet, there are conflicting reports about the relationship between left atrium (LA) dimension and risk for systemic embolization (SE). Previous studies have not investigated the effects of plication on the incidence of systemic embolization.

Physical Location

LocationLocation CodeAvailable FormatAvailability
Philippine Heart Center Medical Library PHC.R.006.91 Fulltext Print Format

 
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