[Extensive Atrial Resection for Marked Atrial Enlargement due to Long-standing Persistent Atrial Fibrillation]

A 67-year-old female, diagnosed with atrial fibrillation over 35 years ago, presented with mild heart failure symptoms. However, due to mild mitral regurgitation, she had been managed conservatively at local hospital. Recently, she developed severe dyspnea and was referred to our institution for surgical intervention. Comprehensive evaluation revealed significant enlargement of both atria, leading to a restrictive ventilatory impairment. The surgical procedure included mitral annulus repair, tricuspid annulus repair, maze procedure, and extensive cylindrical resection of the left atrium, along with right atrial repair, all performed under cardiopulmonary bypass. Post-surgery, her atrial volume decreased from 830 ml to 275 ml, and her vital capacity improved from 1.28 l to 1.77 l. Following the procedure, she maintained sinus rhythm, with complete resolution of her dyspnea. These improvements have been sustained for three years postoperatively.