Background: Giant left atrium secondary to mitral valve disease produces postoperative hazardness in relation to hemodynamic and respiratory management. Many surgical procedures have been proposed to reduce the size of the left atrium. We have combined these surgical techniques and aimed to provide effective reduction in the left atrial size. In this report we describe the techniques used for the giant left atrium reduction in nine consecutive patients with rheumatic mitral valve disease.

Methods:Nine patients (3 men and 6 women aging between 22 and 50 years) were operated for mitral valve replacement and left atrial volume reduction between 2001 and 2003. We used three surgical techniques for the reduction of the giant left atrium (1- Posterior paraannular plication, 2- Posterior wall plication, 3- Wall resection), and outcome of patients were evaluated.

Results:There was no early mortality. Postextubation period was uneventful in all patient. No patient needed reintubation. Preoperative mean left atrial size (7.92 ± 1.6 cm.) was reduced to mean 5.12 ± 0.95 cm, postoperatively. Left ventricle ejection fraction rate improved from 54.22% ± 6.87% to 55.44% ± 6.28% in postoperative first week.

Conclusions: The combined atrial reduction procedures showed marked decrease in the incidence of low output syndrome and respiratory failure postoperatively. We conclude that plication and wall resection procedures are effective techniques for the treatment of compression in the presence of giant left atrium.

Keywords : Giant left atrium, mitral, atrial plication