Endoatriectomy of Porcelain Left Atrium and Interatrial Septum to Approach the Mitral Valve.
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP021
Submission Type:
Abstract Submission
Authors:
Sandeep Shrivastava (1), Shipra Shrivastava (2)
Institutions:
(1) N/A, Indore, India, (2) N/A, India
Submitting Author:
Sandeep Shrivastava
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Co-Author:
Shipra Shrivastava
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Presenting Author:
Sandeep Shrivastava
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Abstract:
Objective:
To evaluate various management options in patients with dense calcification of left atrium and interatrial septum. Surgical challenges encountered in gaining access to the mitral valve.
Method:
A 48 year old female presented with shortness of breath, NYHA class four. She required mechanical ventilation and supportive therapy. Her X-ray chest revealed calcified left atrium. Echocardiography demonstrated critical mitral stenosis, severe tricuspid insufficiency, pulmonary artery systolic pressures of 55mmHg, dense calcification of entire left atrial wall and interatrial septum and specks of calcium in the mitral annulus.The patient was in atrial fibrillation with a large calcified thrombus. Her computed tomography of the chest also confirmed the findings. Repeat echocardiography of the patient revealed the appearance of fresh clots in the left atrium. Hence other alternatives of management were ruled out. After combined discussion surgery was considered as the best possible option. As no soft area could be negotiated through the septum so it was opened with a number 11 knife with great difficulty. The calcified thrombus was dissected and peeled out. There was no visibility to the mitral valve at all after thrombectomy. Hence the entire left atrium along with the septum were decalcified to gain access to the mitral area. Mitral valve was then replaced with a mechanical valve and the tricuspid valve was repaired. Post operative echocardiography revealed good prosthetic mitral valve function and tricuspid repair. She improved gradually and was discharged on twelfth post operative day.
Results:
In this patient, complete endoatriectomy of the left atrium and inter atrial septum was performed to reach the mitral orifice. The calcified thrombus was removed and the mitral valve was replaced with a mechanical valve along with tricuspid valve repair. Patient tolerated the surgery well.
Conclusion:
Porcelain left atrium is a known entity in rheumatic heart disease in which the inter atrial septum is mostly spared. In this patient the septum was also densely calcified prohibiting the access to the mitral valve. As there was calcified thrombus with fresh clots in left atrium so the only option left was to decalcify the septum and perform endoatriectomy of the left atrium to reach the mitral apparatus. Patient behaved well in the postoperative course.
To evaluate various management options in patients with dense calcification of left atrium and interatrial septum. Surgical challenges encountered in gaining access to the mitral valve.
Method:
A 48 year old female presented with shortness of breath, NYHA class four. She required mechanical ventilation and supportive therapy. Her X-ray chest revealed calcified left atrium. Echocardiography demonstrated critical mitral stenosis, severe tricuspid insufficiency, pulmonary artery systolic pressures of 55mmHg, dense calcification of entire left atrial wall and interatrial septum and specks of calcium in the mitral annulus.The patient was in atrial fibrillation with a large calcified thrombus. Her computed tomography of the chest also confirmed the findings. Repeat echocardiography of the patient revealed the appearance of fresh clots in the left atrium. Hence other alternatives of management were ruled out. After combined discussion surgery was considered as the best possible option. As no soft area could be negotiated through the septum so it was opened with a number 11 knife with great difficulty. The calcified thrombus was dissected and peeled out. There was no visibility to the mitral valve at all after thrombectomy. Hence the entire left atrium along with the septum were decalcified to gain access to the mitral area. Mitral valve was then replaced with a mechanical valve and the tricuspid valve was repaired. Post operative echocardiography revealed good prosthetic mitral valve function and tricuspid repair. She improved gradually and was discharged on twelfth post operative day.
Results:
In this patient, complete endoatriectomy of the left atrium and inter atrial septum was performed to reach the mitral orifice. The calcified thrombus was removed and the mitral valve was replaced with a mechanical valve along with tricuspid valve repair. Patient tolerated the surgery well.
Conclusion:
Porcelain left atrium is a known entity in rheumatic heart disease in which the inter atrial septum is mostly spared. In this patient the septum was also densely calcified prohibiting the access to the mitral valve. As there was calcified thrombus with fresh clots in left atrium so the only option left was to decalcify the septum and perform endoatriectomy of the left atrium to reach the mitral apparatus. Patient behaved well in the postoperative course.
Mitral Conclave:
Mitral Valve Replacement
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