Клінічна хірургія (Nov 2021)
The left atrium plasty in surgical correction of combined mitral-aortal failure, complicated by the left-sided atriomegaly
Abstract
Objective. Studying of possibilities of the left atrium triangular plasty procedure in correction of combined mitral-aortal failure, complicated by the left-sided atriomegaly. Materials and methods. Into the analysis the results of surgical treatment in 360 patients, suffering combined mitral-aortal failure, combined with left-sided atriomegaly, who were operated in Amosov National Institute of Cardiovascular Surgery through period from 01.01.2006 to 01.01.2021 yr, were included. In the main group, consisting of 73 patients, original procedure of the left atrium triangular plasty was performed while correcting a combined mitral-aortal failure. In the control group, consisting of 287 patients, correction of combined mitral-aortal failure in presence of concomitant left-sided atriomegaly was performed only. Results. Of 73 operated patients of the main group 3 died (lethality have constituted 4.1%). Dynamics of echocardiographic indices in the main group of patients in accordance to stagesof treatment was following: definitely-systolic index of the left ventricle – (69.1 ± 12.1) ml/m2 preoperatively, (59.3 ± 8.5) ml/m2 postoperatively, (48.4 ± 9.5) ml/m2 in late period; the ejection fraction of the left ventricle – 0.51 ± 0.05 preoperatively, 0.54 ± 0.05 postoperatively, 0.56 ± 0.04 in late period. Diameter of the left atrium – (65.8 ± 4.1) mm preoperatively, (52.3 ± 2.1) mm postoperatively, (53.5 ± 2.2) mm in late period. Of 287 operated patients of control group 9 died (lethality have constituted 3.1%). Dynamics of echocardiographic indices in the main group patients on the treatment stages was following: definitely-systolic index of the left ventricle – (68.3 ± 11.3) ml/m2 preoperatively, (60.4 ± 9.3) ml/m2 postoperatively, (52.7 ± 7.2) ml/m2 in late period; the ejection fraction of the left ventricle – 0.52 ± 0.05 preoperatively, 0.53 ± 0.05 postoperatively, 0.5 ± 0.04 in late period. Diameter of the left atrium – (66.5 ± 3.7) mm preoperatively, (64.5 ±3.3) mm postoperatively, (73.5 ± 2.8) in late follow-up period. Conclusion. While performing operation for the left-sided atriomegaly the correction of triangular plasty of the left atrium constitutes a mini-invasive and effective procedure, leading to significant improvement in the left atrium morphometry and accompanied by low risk of lethality as well as thromboembolic complications.
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