Autotransplantation as a method for treatment of a giant left atrium
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Autotransplantation as a Method for Treatment of a Giant Left Atrium. Mitrev Z, Anguseva T , Vogt P. Special hospital for Cardiosurgery “Fillip II”, Skopje, Macedonia. Cardiosurgery - Skopje. Background :.

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Autotransplantation as a method for treatment of a giant left atrium
Autotransplantation as a Method for Treatment of a Giant Left Atrium

Mitrev Z, Anguseva T, Vogt P

Special hospital for Cardiosurgery “Fillip II”, Skopje, Macedonia

Cardiosurgery - Skopje


Background
Background Left Atrium:

Heart autotransplantation has been used for treatment of several cardiac diseases such are:

- long QT Syndrome [Pfeiffer, 1992].

- cardiac tumors

- refractory Printz-metal angina

- permanent atrium fibrillation due to giant left atrium combined with mitral valve disease (Giovanni Troise et al, 2004)

Cardiosurgery - Skopje


Giant la clinical expression
Giant LA – clinical expression Left Atrium

- Rhythm disturbances

- blood stagnation in the LA  consequent thrombosis formation

- pressure of the : - left ventricle

- pulmonary vessels

- bronchial tree

Ultrasound findings: - giant LA with spontaneous echo contrast

- thromboembolism

Cardiosurgery - Skopje


Type of surgery for la size reducing
Type of surgery for LA size reducing Left Atrium

Para-annular wall plication

Posterior wall plication

Ligation of the appendix of the LA

Partial auto-transplantation for pts with LA<8cm diameter

Auto-transplantation for pts with LA>8cm diameter

Cardiosurgery - Skopje


Case report patient characteristics
Case – report : patient characteristics Left Atrium

2 cases:

1st 58 –year-old man / non-smoker

Severe mitral insufficiency, combined with a tricuspid one (myxomatous degeneration combined with severe atherosclerosis) LA 15x12cm

- dilated cardiomyopathy (7y), with dominant right heart failure

- cahexia - BW=52.4kg, BH= 162cm, BSA = 1.52m2

- ECG- atrial fibrilloflater / last 3 years

Comorbidities: lever cirrhosis and ascites; benign prostate hyperplasia

2nd 61y old lady / non smoker

Terminal stadium of mitral valve stenosis with tricuspid insuff. LA 14x16cm

Cahexia –BW=48kg,BH 158cm,BSA = 1.2m2

ECG – atrial fibrilloflutter

Comorbidities : liver insuff.

Both pat. were refractory of the optimal medical therapy

Cardiosurgery - Skopje


Autotransplantation as a method for treatment of a giant left atrium

Diagnosis Left Atrium

  • TTE & TEE – giant left atrium ( 15 x 16cm/14x14cm) & small atrium - septal aneurysm

    & severe MR & TR

Cardiosurgery - Skopje


Autotransplantation surgery
Autotransplantation - surgery Left Atrium

1st pat 2nd pat

CBP time 89 min / t=36°C 82min/ t=35,8°C

aorta clamping time 44 min 42min

Heart out of the chest 9 min 8,5min

retrograde cardioplegia through the sinus coronaries

mitral annuli reconstruction mechanic mitral valve

reduction of the left atrium with atria-septal plastic

tricuspid valve reconstruction

Cardiosurgery - Skopje


Surgery
Surgery Left Atrium

Cardiosurgery - Skopje


Postoperative monitoring
Postoperative monitoring Left Atrium

Cardiac status:

- atrium fibrillation : convert in sinus rhythm after 24 hours postoperatively by performing Amiodarone (both pts):

after 3 months after 6 months

EDV=175/145ml EDV=150/102ml

ESV=90/78ml ESV = 78/67ml

EF= 40/45% EF = 45/50%

CO=3.8/3.6l CO=4.7/5.1l

CI= 2.9/3.0 CI=3.3/3.8

LA=58/49 mm LA=55/52mm

no mitral and tricuspid valve regurgitation

ECG : sinus rhythm with intermittent atrium fibrillation

Cardiosurgery - Skopje


Autotransplantation as a method for treatment of a giant left atrium

Follow up Left Atrium

  • Patients get 10 / 12kg on weight

  • Ascites was completely cured conservatively after 3

    months (haemodynamic improvement).

  • NYHA class II, good quality of life

  • Medical treatment with:

    - digitalis,

    - ACE inhibitors

    - spironolacton

    - diuretics

    - amjodarone (first 3 months)

Cardiosurgery - Skopje


C o m m e n t
C o m m e n t Left Atrium

-Autotransplantation seems to be an efficient method to reduce extreme LA dilatation.

- Eventually should be considered as a method of choice for patients with long lasting mitral valve disease and severe enlargement of the left atrium

Cardiosurgery - Skopje