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Recovery of atrial function after atrial compartment operation for chronic atrial fibrillation in mitral valve
K G Shyu1, J J Cheng, J J Chen
1Department of Emergency Medicine, Shin-Kong Memorial Hospital, Taipei, Taiwan, Republic of China.
Insights
Atrial compartment operation combined with mitral valve surgery effectively restored sinus rhythm in patients with chronic atrial fibrillation. Atrial function recovered significantly over six months, with the right atrium showing earlier improvement.
Area of Science:
- Cardiology
- Cardiac Surgery
- Arrhythmology
Background:
- Chronic atrial fibrillation is a common complication of mitral valve disease, leading to increased morbidity and mortality.
- Mitral valve surgery alone has limited success in eliminating chronic atrial fibrillation.
Purpose of the Study:
- To evaluate the recovery of atrial function following atrial compartment operation and mitral valve surgery.
- To assess the efficacy of this combined surgical approach in managing chronic atrial fibrillation in mitral valve disease.
Main Methods:
- Prospective study involving 22 patients undergoing mitral valve surgery and atrial compartment operation.
- Doppler echocardiography used for pre-operative and post-operative assessments (1 week, 2 months, 6 months).
- Measured parameters included peak early diastolic (E) and atrial (A) filling velocities, and A/E ratios for mitral and tricuspid valves.
Main Results:
- Sinus rhythm was restored in 91% of patients immediately post-operation and maintained in 64% at 6 months.
- Significant recovery of both left and right atrial contractile function was observed by 6 months.
- Doppler-measured atrial filling velocities and ratios showed significant improvement from 1 week to 6 months post-operation (p < 0.001).
Conclusions:
- Atrial compartment operation can effectively eliminate chronic atrial fibrillation associated with mitral valve disease.
- The combined surgical approach demonstrated no mortality or significant complications.
- Both left and right atrial mechanical function recover and improve post-operatively, with right atrial function recovering sooner.
Objectives:
We prospectively studied the recovery of atrial function after atrial compartment operation and mitral valve surgery in patients with chronic atrial fibrillation caused by mitral valve disease.
Background:
Chronic atrial fibrillation is the most common arrhythmia in mitral valve disease. This arrhythmia is associated with excessive morbidity and mortality. Mitral valve surgery alone rarely eliminates it.
Methods:
Twenty-two patients underwent mitral valve surgery and a new surgical method, atrial compartment operation. Doppler echocardiography was performed in all patients before operation and at 1 week and 2 and 6 months after operation in the successful cardioversion group. Peak early diastolic (E) and atrial (A) filling velocities, peak A/E velocity ratio and A/E integral ratio of the mitral and tricuspid valves were measured.
Results:
Sinus rhythm was restored immediately after operation in 91% of patients and was maintained for > 1 week in 15 (68%) of 22 patients and > 6 months in 14 (64%) of 22. Eleven of 15 patients had left atrial paralysis (A/E integral ratio 0) at 1 week and 6 of 14 patients at 2 months. Nine of 15 patients had right atrial paralysis (A/E integral ratio 0) at 1 week and 1 of 14 patients at 2 months. Both left and right atrial contractile function (presence of an A wave on Doppler findings) was detected at 6 months in 14 patients. Mean (+/- SD) peak atrial filling velocity of the mitral valve was 15 +/- 26 cm/s at 1 week, 38 +/- 39 cm/s at 2 months and 93 +/- 32 cm/s at 6 months (p < 0.001). Mean peak atrial filling velocity of the tricuspid valve was 14 +/- 19 cm/s at 1 week, 33 +/- 19 cm/s at 2 months and 50 +/- 19 cm/s at 6 months (p < 0.001). Peak early diastolic and atrial filling velocities, peak A/E velocity ratio and A/E integral ratio of the mitral and tricuspid valves increased significantly from 1 week to 6 months.
Conclusions:
Chronic atrial fibrillation in mitral valve disease can often be eliminated by atrial compartment operation. No surgical mortality or significant complications were encountered. Both left and right atrial function, as manifested by Doppler findings, recover after compartment operation and improve over time. The mechanical function of the right atrium recovers earlier than that of the left.