ABSTRACT
The giant left atrium associated with mitral valve disease frequently produces postoperative hazardness in relation to hemodynamic and respiratory management. We have defined the most serious disorders induced by the presence of giant left atrium in three categories as follows. First, hemodynamic disturbance by the compression of left ventricular wall by downward extension of left atrium (type I), secondly, respiratory disturbance yielded by the compression of left main bronchus by upward extension of left atrium (type II), thirdly, compression of right middle lobe by rightward extension of left atrium (type III). A new procedure of para-annular, superior and right-side plication methods were derived as the procedure to relieve those compressions induced by giant left atrium. Up to the present, 47 patients with giant left atrium underwent surgery, twelve of valvular procedure only and thirty-five of valvular as well as plication procedure. The incidence of postoperative low output syndrome and respiratory failure were evaluated. The plication procedure showed marked decrease in the incidence of low output syndrome and respiratory failure postoperatively, eventual significant decrease in mortality rate. We conclude that plication procedure is very effective for the treatment of compression in the presence of giant left. atrium.
