Reduction plasty for giant left atrium causing dysphagia: a case report
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CASE REPORT
Reduction plasty for giant left atrium causing dysphagia: a case report Abdul Kerim Buğra1 · Ersin Kadiroğulları1 · Burak Onan1 Received: 24 June 2020 / Accepted: 8 September 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract The giant left atrium is described as an atrium with a diameter of 6.5 cm or larger and which can rarely cause dysphagia by compressing on the esophagus. Left atrial enlargement is usually seen due to mitral valve disease. The most common indication of left atrial volume reduction plasty during mitral valve surgery is the compression symptoms. We performed mitral valve replacement in our case and transformed the giant left atrium into an anatomical chamber with the technique we applied. In this way, we successfully eliminated cardiac and compression symptoms. Cardiac causes of dysphagia are rarely seen, usually, cardiac complaints are more prominent than dysphagia. However, it should be kept in mind in the differential diagnosis. We think that cardiac mortality and morbidity may be prevented with early diagnosis and treatment. Keywords Giant left atrium · Atrial reduction · Dysphagia
Introduction
Case report
Chronic rheumatic mitral valve disease left ventricular failure, chronic atrial fibrillation and left-to-right shunts are frequently involved in the etiology of left atrial enlargement. Giant left atrium (GLA) term is used for an atrium with a diameter of 6.5 cm or larger [1]. The massive expansion of cardiac structures can cause compression symptoms such as dysphagia, dysphonia, or Ortner syndrome. The most common indication of left atrial volume reduction plasty during mitral valve surgery is the compression symptoms [2]. The choice of left atrial reduction technique should consider factors such as the patient’s comorbidities, major bleeding risk, or prolongation of cardiopulmonary bypass time.
A 60-year-old woman had complaints of dysphagia against solid foods for the past 3 years. Internal medicine examinations showed that gastroesophageal reflux and gastritis were detected, but the etiology of dysphagia was not clarified. She was treated with antireflux, and antacid medications. After a while, the patient admitted to the hospital with New York Heart Association class 3 dyspnea symptom and rheumatoid mitral valve disease was detected. The echocardiographic evaluation showed a left ejection fraction of 45%, a severe mitral and tricuspid regurgitation, and left atrial dimensions of 5.7 × 9.5 × 12.5 cm. Coronary angiography was normal. There was chronic atrial fibrillation which was not affecting hemodynamics. Computerized tomography revealed compression of the middle segment of the esophagus by the left atrium (Fig. 1a). Surgery was planned to relieve compression symptoms, to decrease blood stagnation, and thrombus formation and to avoid associated thromboembolization. During operation, the right atriotomy was performed and trans-septal approach was used. First, the posterior atrial wall was plicated parallel to the p2-3 segments of the mitral annu
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