Impact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function Akira Marui, MD,

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Impact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function Akira Marui, MD, PhD, Yoshiaki Saji, MD, Takeshi Nishina, MD, PhD, Eiji Tadamura, MD, PhD, Shotaro Kanao, MD, Takeshi Shimamoto, MD, Nozomu Sasahashi, MD, Tadashi Ikeda, MD, PhD, Masashi Komeda, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 6, Pages 1297-1305 (June 2008) DOI: 10.1016/j.jtcvs.2008.02.026 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Maze procedure with LA volume reduction surgery. a, Schema of LA volume reduction surgery. The redundant LA wall between the mitral annulus and the left pulmonary veins was plicated with continuous horizontal mattress sutures (anatomic isolation). The plicated area was isolated by means of confinement cryoablation along the suture line (electrical isolation). b, MRI of LA plicated area. LA is plicated in areas 1 and 2. 1: Right lateral wall 2: Redundant LA wall between the mitral annulus and the left pulmonary veins. LAA, Left atrial appendage; SVC, superior vena cava; IVC, inferior vena cava; FO, foramen ovale; SN, sinus node; CS, coronary sinus; MV, mitral valve; TV, tricuspid valve; LV, left ventricle; RA, right atrium; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1297-1305DOI: (10.1016/j.jtcvs.2008.02.026) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 LA volume-time curve by MRI. A, Typical LA volume-time curve; there is an increase in atrial volume in late diastole. B, If there was a plateau during late diastole, the booster pump volume was calculated as the volume decrease during the final 200 ms period of the cardiac cycle. C, If there was continuous downsloping during diastole, the reservoir volume was taken to be the volume decrease before the final 200 ms period of the cardiac cycle. A: Minimum volume. B: Maximum volume. C: End of rapid emptying volume. D: Before contraction volume. Booster: booster pump phase. Reservoir: reservoir phase. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1297-1305DOI: (10.1016/j.jtcvs.2008.02.026) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Restoration of LA geometry and mechanical functions in patients with postoperative maintenance of sinus rhythm. VR: Patients with LA volume reduction. Control: Patients without LA volume reduction. Pre, preoperation. 1 month: 1 month after the operation. Mean follow-up period was 13.8 months. ∗P < .01. ∗∗P < .001 vs control. †P < .01 vs preoperation. ‡P < .05 vs 1 month. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1297-1305DOI: (10.1016/j.jtcvs.2008.02.026) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Representative magnetic resonance imaging scans of LA volume reduction surgery (at LA end systole). Preoperative giant left atrium was reduced by LA volume reduction surgery, and the reduction was maintained 1 year after the operation. 1 month: 1 month after the operation. 12 months: 12 months after the operation. LA, Left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1297-1305DOI: (10.1016/j.jtcvs.2008.02.026) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions