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ObjectiveLeft atrial geometry and mechanical functions exert a profound effect on left ventricular filling and overall cardiovascular performance. We sought to investigate the perioperative factors that influence left atrial geometry and mechanical functions after the Maze procedure in patients with refractory atrial fibrillation and left atrial enlargement.MethodsSeventy-four patients with atrial fibrillation and left atrial enlargement (diameter ≥ 60 mm) underwent the Maze procedure in association with mitral valve surgery. The maximum left atrial volume and left atrial mechanical functions (booster pump, reservoir, and conduit function [%]) were calculated from the left atrial volume-cardiac cycle curves obtained by magnetic resonance imaging. A stepwise multiple regression analysis was performed to determine the independent variables that influenced the postoperative left atrial geometry and function.ResultsThe multivariate analysis showed that left atrial reduction surgery concomitant with the Maze procedure and the postoperative maintenance of sinus rhythm were predominant independent variables for postoperative left atrial geometry and mechanical functions. Among the 58 patients who recovered sinus rhythm, the postoperative left atrial geometry and function were compared between patients with (VR group) and without (control group) left atrial volume reduction. At a mean follow-up period of 13.8 months, sinus rhythm recovery rate was better (85% vs 68%, P < .05) in the VR group and maximum left atrial volume was less (116 ± 25 mL vs 287 ± 73 mL, P < .001) than in the control group. The maximum left atrial volume reduced with time only in the VR group (reverse remodeling). Postoperative booster pump and reservoir function in the VR group were better than in the control group (25% ± 6% vs 11% ± 4% and 34% ± 7% vs 16% ± 4%, respectively, P < .001), whereas the conduit function in the VR group was lower than in the control group, indicating that the improvement of the booster pump and reservoir function compensated for the conduit function to left ventricular filling.ConclusionLeft atrial reduction concomitant with the Maze procedure helped restore both contraction (booster pump) and compliance (reservoir) of the left atrium and facilitated left atrial reverse remolding. Left atrial volume reduction and postoperative maintenance of sinus rhythm may be desirable in patients with refractory AF and left atrial enlargement.

ObjectiveLarge left atrial diameter is reported to be a predictor for recurrent atrial fibrillation after the Cox maze procedure, and left atrial diameter by itself influences the chance of sinus rhythm recovery, as well as maintenance of sinus rhythm. However, additional cut-and-sew procedures to decrease left atrial diameter extend operative time and can cause bleeding. Thus we developed a no-bleeding, faster, and therefore less invasive left atrial volume reduction technique to enhance the Cox maze procedure.MethodsThe modified Cox maze III procedure with cryoablation or the left atrial maze procedure in association with mitral valve surgery was performed in 80 patients with atrial fibrillation and enlarged left atria (≥60 mm). Among them, 44 patients had the concomitant volume reduction technique (VR group); continuous horizontal mattress sutures for left atrial plication were placed on the left atrial wall along the pulmonary vein isolation line. Cryoablation was applied to the suture line so that the plicated left atrium is anatomically and electrically isolated. Another 36 patients did not have the volume reduction technique (control group).ResultsThe VR group had preoperative left atrial diameters similar to those of the control group (67.1 ± 7.8 vs 64.5 ± 6.7 mm) and a longer preoperative duration of atrial fibrillation (14.1 ± 5.4 vs 9.5 ± 5.1 years, P < .05) but had smaller postoperative left atrial diameters (47.6 ± 6.3 vs 62.1 ± 7.9 mm, P < .01). There were no differences in mean crossclamp/bypass time and chest tube drainage for 12 hours between the groups. Twelve months after surgical intervention, the sinus rhythm recovery rate of the VR group was better than that of the control group (90% vs 69%, P < .05).ConclusionsEven in patients with long-standing atrial fibrillation and an enlarged left atrium, maze procedures concomitant with the novel left atrial volume reduction technique improved the sinus rhythm recovery rate without increasing complications. Although further study with a larger number of patients and a longer follow-up period is needed, this safe and thus far potent technique that catheter-based ablation cannot copy might extend indication of the Cox maze procedure for patients with tough atrial fibrillation.

The treatment of aortic root dilatation with a leaking valve requires a multimodal approach, including root reimplantation or remodeling with or without tailoring of the sinotubular junction and valvular apparatus. However, valve-sparing procedures are time-consuming, technically demanding, and associated with intraoperative bleeding. Here we report a novel reconstruction method for the treatment of annuloaortic ectasia with a leaking valve. In this method the dilated sinuses were excluded, and the annulus was effectively suspended by suturing a bovine pericardial patch inside the dilated aortic root.

Cardiac myxoma sometimes presents constitutive symptoms such as fever and weight loss because of a production of interleukin-6 (IL-6). Castleman’s disease (CD) presents constitutional symptoms with lymphadenopathy, plasma cell infiltration, polyclonal hypergammaglobulinemia, and inflammatory reaction, which has been reported to be caused by an overproduction of IL-6. Here, we report a rare case of IL-6-producing cardiac myxoma resembling multicentric CD with plasma cell infiltration.

ObjectiveThe purpose of this study was to evaluate the therapeutic efficacy of the combined growth factor therapy with an omental flap in a rabbit model of chronic myocardial ischemia.MethodsChronic ischemia was created in rabbits by placing a constrictor on the left circumflex artery. Four weeks later the animals were divided into 3 groups: group FG, in which a gelatin hydrogel sheet incorporating 100 μg of basic fibroblast growth factor was placed over the left circumflex region followed by covering with the omental flap including the intact gastroepiploic artery; group F, in which only the basic fibroblast growth factor sheet was placed; and group N, in which no treatment was done.ResultsCine magnetic resonance imaging analysis showed a greater percentage wall thickening in the left circumflex region in group FG than in other groups (group FG, 49.2% ± 4.5%; group F, 41.2% ± 3.8%; group N, 32.1% ± 2.5%, P =.035, group FG vs group F). A colored microsphere assay showed higher perfusion in the left circumflex region in group FG than in group F. Perfusion in the left circumflex region was decreased after clamping the gastroepiploic artery pedicle in group FG (before clamping, 2.83 ± 0.72 mL · min−1 · g−1; after clamping, 1.93 ± 0.59 mL · min−1 · g−1; P < .01). In vivo angiography via gastroepiploic artery showed direct “to-and-fro” visible collaterals between the gastroepiploic and occluded left circumflex coronary arteries in group FG.ConclusionThe combined growth factor therapy with an omental flap induced arteriogenesis and provided additional perfusion via the gastroepiploic artery to ameliorate regional dysfunction in the chronically ischemic myocardium.