Format

Send to

Choose Destination
See comment in PubMed Commons below
Heart Rhythm. 2013 Dec;10(12):1839-42. doi: 10.1016/j.hrthm.2013.09.010. Epub 2013 Sep 16.

Symptomatic pulmonary hypertension with giant left atrial v waves after surgical maze procedures: evaluation by comprehensive hemodynamic catheterization.

Author information

1
Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: Terrence.D.Welch@Hitchcock.org.

Abstract

BACKGROUND:

The surgical maze procedure is highly effective in treating symptomatic atrial fibrillation but may have detrimental effects on left atrial (LA) contractile function and compliance.

OBJECTIVE:

To describe a series of patients presenting with symptomatic pulmonary hypertension due in part to LA dysfunction after surgical maze procedures.

METHODS:

This report includes 9 patients who (1) presented to Mayo Clinic (Rochester, MN) between 2008 and 2012 with unexplained dyspnea and pulmonary hypertension after the surgical maze procedure, (2) underwent comprehensive hemodynamic catheterization with transseptal measurement of LA pressure, (3) had large v waves on LA pressure waveforms, and (4) did not have significant mitral valve regurgitation or stenosis or pulmonary vein stenosis.

RESULTS:

Invasive hemodynamic assessment revealed (1) severe pulmonary hypertension (mean pulmonary pressure 47 ± 6 mm Hg), (2) severe LA hypertension (27 ± 4 mm Hg), (3) giant LA v waves (to 50 ± 8 mm Hg), (4) absence of LA or left ventricular a waves, and (5) blunted x descents (2 ± 1 mm Hg). Left ventricular end-diastolic pressure was also elevated (20 ± 5 mm Hg).

CONCLUSIONS:

Abnormalities in LA compliance and contractility may lead to giant LA v waves and symptomatic pulmonary hypertension after surgical maze procedures. This syndrome should be considered in the differential diagnosis for pulmonary hypertension and underscores the importance of comprehensive hemodynamic catheterization.

KEYWORDS:

AF; Ablation; Atrial fibrillation; Heart failure; Hemodynamics; LA; LV; Left atrial function; NYHA; New York Heart Association; PHTN; Pulmonary hypertension; RF; atrial fibrillation; left atrial/atrium; left ventricular; pulmonary hypertension; radiofrequency

PMID:
24050987
DOI:
10.1016/j.hrthm.2013.09.010
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center