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Correlation of left atrial appendage histopathology, cardiac rhythm, and response to maze procedure in patients undergoing surgery for rheumatic valvular heart disease

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Abstract

Introduction

All patients with atrial fibrillation (AF) do not revert to sinus rhythm (SR) with hemodynamic correction and procedures to restore SR. We co-relate left atrial appendage (LAA) histopathology and cardiac rhythm, and its response to maze procedure, in patients undergoing surgery for rheumatic valvular heart disease.

Methods

LAA histopathology was studied in two groups of 25 patients each, with pre-operative sinus rhythm (Group A) and atrial fibrillation for >3 months (Group B). 16 patients of Group B underwent modified maze procedure. LAA histopathology was classified in three grades based on endocardial inflammation and myofibril hypertrophy. The rhythm of all patients was observed post-operatively.

Results

In group A, 20 (80%) of 25 patients had Grade I–II changes in LAA, and all remained in SR. 5 (20%) patients had grade III changes, of which 2 (40%) went into AF on follow up. In group A, of 17 (68%) patients with stenotic or mixed mitral valve lesions, 15 (88%) had grade I–II changes in LAA. While of 8 (32%) patients with MR, 3 (37.5%) had grade III changes. In group B, 13 (52%) of 25 patients had grade I–II changes, while 12 (48%) had grade III changes in LAA. Of 14 (56%) patients with stenotic or mixed mitral valve lesions, 13 (92%) had grade I–II changes in LAA. While 9 (81%) of 11 patients with MR had grade III changes in LAA. Of the 16 patients in group B undergoing maze, 9 (56%) patients of whom 8 (88%) had grade I–II changes converted to SR, whereas 7 (44%) patients, all with grade III changes remained in AF.

Conclusions

Patients in AF and with MR have predominantly grade III changes in LAA. Patients with grade III changes on follow up have tendency to remain in AF even after modified maze procedure.

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Authors and Affiliations

  1. Dr PK Sen Department of Cardiovascular and Thoracic Surgery, Department of Pathology (Cardiovascular and Thoracic Section), Seth GS Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra

    Ashutosh Singh MS, Bhavin Desai M.Ch., Jayant Khandekar M.Ch., Nandkishore Agrawal M.Ch., Pradeep Vaideeswar MD, Anil Patwardhan M.Ch. &  Jagdish Khandeparkar M.Ch.

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  1. Ashutosh Singh MS
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  2. Bhavin Desai M.Ch.
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  3. Jayant Khandekar M.Ch.
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  4. Nandkishore Agrawal M.Ch.
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  5. Pradeep Vaideeswar MD
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  6. Anil Patwardhan M.Ch.
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  7. Jagdish Khandeparkar M.Ch.
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Singh, A., Desai, B., Khandekar, J. et al. Correlation of left atrial appendage histopathology, cardiac rhythm, and response to maze procedure in patients undergoing surgery for rheumatic valvular heart disease. Indian J Thorac Cardiovasc Surg 21, 5–8 (2005). https://doi.org/10.1007/s12055-005-0062-y

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  • DOI: https://doi.org/10.1007/s12055-005-0062-y

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