With the deepening of research on cardiovascular diseases, left atrial remodeling (LAR) and left atrial reverse remodeling (LARR) have become important research hotspots, closely related to various adverse cardiovascular pathological changes. As a non-invasive and convenient diagnostic tool, echocardiography plays a crucial role in the diagnosis, treatment monitoring, and prognosis evaluation of LAR and LARR. This article reviews the research progress of echocardiography in evaluating LAR and LARR, involving transthoracic echocardiography, tissue Doppler imaging, two-dimensional speckle tracking echocardiography, and three-dimensional speckle tracking echocardiography, and explores their advantages and limitations in clinical practice.
Objective To investigate the clinical characteristics of primary malignant tumors of the left atrium and the late results of surgical treatment. Methods The clinical experience with surgical treatment of 13 primary malignant tumors of left atrium was analyzed retrospectively. Complete resection of malignant tumor was achieved in 7 cases(53.8％ )，and subtotal resection was achieved in 3 cases(23.0％), only biopsy was performed in 2 patients(15.4％ )because of extensive metastasis of tumor. Heart transplantation was performed in 1 case(7.7％). Results There was no hospital death. The pathological diagnosis was undifferentiated sarcoma in 5 cases, leiomyosarcoma in 2 cases, malignant transformation of myxoma in 2 cases, angiosarcoma in 1 case, fibrosarcoma in 1 case, malignant fibrous histocytoma in 1 case and malignant hemangiopericytoma in 1 case. There were 11 patients followedup for 3 months to 65 months and showed 9 late death due to recurrence or metastasis. There was 2 patients lost of follow-up. Conclusion Primary malignant tumors of the left atrium should be resected to relieve symptoms caused by local tumor growth. Surgery provides control of primary tumor and allows the potential for cure or longterm survival with effective adjuvant therapy. The prognosis of these patients is still poor.
ObjectiveTo investigate the feasibility, safety and accuracy of inserting a left atrial piezometer tube and pulmonary artery flotation catheter (PAFC)via the internal jugular vein (IJV)for postoperative monitoring of adult patients with pulmonary arterial hypertension (PAH)after open cardiac surgery. MethodsA prospective study was conducted in 100 patients aged over 18 years who underwent open cardiac surgery in Wuhan Asia Heart Hospital from 2010 to 2012. There were 43 male and 57 female patients with their age of 46-65 (47±16)years. All the patients were divided into 2 groups, including 50 patients with severe PAH who underwent heart valve replacement (HVR)in group A, and 50 patients with mild to moderate PAH who underwent HVR in group B. All the patients received insertion of ARROW 5 Fr three-cavity catheter by piercing the atrial septum via IJV for continuous monitoring of left atrial pressure (LAP), and insertion of ARROW 8 Fr high-flow sheath for PAFC implantation via IJV in the same side. LAP and pulmonary artery wedge pressure (PAWP)were continuously monitored after the patients entering the intensive care unit (ICU). The corelation and accuracy of LAP and PAWP were observed in the 2 groups. ResultsAll the patients successfully received continuous LAP and PAWP monitoring without serious catheter-related complications. There was no statistical difference in operation time or extracorporeal circulation time between group A and B (P > 0.05). There was statistical difference in postoperative mechanical ventilation time and length of ICU stay between the 2 groups (P < 0.05). Mean pulmonary artery pressure (PAPmean), mean LAP (LAPmean), mean PAWP (PAWPmean), and mean difference between PAWP and LAP (PAWP-LAPmean)of group A were significantly higher than those of group B (P < 0.01). PAWP was well correlated with LAP in both groups, and the correlation in group A was significantly milder than that in group B (P < 0.01). ConclusionIt is safe and feasible for LAP and PAFC monitoring via IJV after cardiac surgery. PAWP can not accurately reflect left ventricular preload, and LAP is more accurate to monitor left ventricular preload for patients with severe PAH.
ObjectiveTo analyze the clinical characteristics of stiff left atrial syndrome (SLAS) after Mei mini maze procedure for atrial fibrillation (AF), and to explore its risk factors and treatments. Methods We retrospectively analyzed the clinical data of the patients who underwent Mei mini maze procedure in Xinhua Hospital between 2010 and 2020. According to whether SLAS occurred in the early postoperative period, patients were divided into a SLAS group and a non-SLAS group. The basic data, perioperative echocardiogram and laboratory test indexes of the two groups were compared. Results A total of 1 056 patients were collected. There were 672 (63.6%) males with an average age of 63.6±9.3 years, including 489 patients with persistent AF and 567 patients with paroxysmal AF. Fourteen (14/1 056, 1.3%) patients developed SLAS, with an average occurrence time of 2.1±1.1 days after the surgery. The average follow-up time of the whole group was 21.4±7.8 months. Two patients in the SLAS group developed SLAS again after discharge, and the occurrence time was 3 weeks and 4 weeks after the operation, respectively; while no SLAS occurred after discharge in the non-SLAS group. Diabetes and small preoperative left atrial diameter were risk factors for SLAS after surgery. Patients with SLAS had a good prognosis after adequate diuretic therapy. Conclusion The incidence of SLAS after Mei mini maze procedure for AF is low, and it mostly occurs in the early postoperative period. After adequate diuretic treatment, the prognosis is good.
This paper aims to explore the feasibility of building a finite element model of left atrial diverticulum (LAD) using reverse engineering software based on computed tomography (CT) images. The study was based on a three-dimensional cardiac CT images of a atrial fibrillation patient with LAD. The left atrium and LAD anatomical features were accurately reproduced by using Geomagic Studio 12 and Mimics 15 reverse engineering software. In addition, one left atrial model with LAD and one without LAD were created with ANSYS finite element analysis software, and the validity of the two models were verified. The results show that it is feasible to establish the LAD finite element model based on cardiac three-dimensional CT images using reverse engineering software. The results of this paper will lay a theoretical foundation for further hemodynamic analysis of LAD.
ObjectiveTo investigate influence of left atrial contraction on lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation. MethodsClinical data of 57 patients with lone atrial fibrillation underwent minimally invasive radiofrequency ablation in Department of Cardiothoracic Surgery, Xinhua Hospital, Medical School of Shanghai Jiaotong University from September 2010 to December 2011 were retrospectively analyzed. According to the absence of mitral A velocity, patients were divided into Group A (absence of mitral A velocity, 20 patients with their age of 56.32±17.18 years, including 5 females) and Group B (mitral A velocity exists, 37 patients with their age of 60.33±11.22 years, including 17 females). Minimally invasive radiofrequency ablation via thoracoscope were performed in all patients. Preoperative and postoperative left atrial diameter (LAD), left ventricular ejection fraction (LVEF) and mitral A velocity, as well as clinical and follow-up data were recorded and compared. ResultsPreoperative clinical characters were not statistically different between two groups (P > 0.05). All the patients were followed up for 24.3±8.8 months (range, 12-26 months). Rate of postoperative atrial fibrillation recurrence in group A was significantly higher than that in group B (20.0% vs. 2.7%, P < 0.05). LAD and LVEF of 57 patients at 6 months after surgery were significantly higher than preoperative LAD and LVEF (P < 0.05), but there was no statistic difference between two groups (P > 0.05). ConclusionDamage of left atrial contraction was related to lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation. Absence of mitral A velocity could be a crucial predictor of postoperative lone atrial fibrillation recurrence.
Objective To explore the operability of concomitant ablation for the patients with valvular heart diseases with left atrium bigger than 60 mm. Methods We prospectively included 306 patients with concomitant ablation in our hospital between 2013 and 2015 year. Based on diameter of left atrium measured by intra-operative transesophageal echocardiography (TEE), we separated these patients into two groups including a group L (left atrium >60 mm, 93 patients, 55 males and 38 females at age of 57.0±10.1 years) and a group S (left atrium <60 mm, 213 patients, 120 males and 93 females at age of 55.2±9.9 years) and followed them on 4 time points (time on discharge, three months, six months, and one year after surgery). Then, we analyzed the impact of left atrial size on cardioversion outcome of surgical ablation based on the following data. Results The successful rate of the group S and the group L in the 4 time points was 72.8% vs. 75.3%, 74.2% vs. 75.3%, 78.9% vs. 77.4%, and 77.0% vs. 77.4%, respectively . The result of both univariate logistic regression analysis and receiver operation characteristic(ROC) curve analysis showed that there was no statistical difference in cardioversion rates between the group S and the group L. And there was no evident correlation between size of left atrium and ablation failure. Conclusion Patients with left atrium enlarged from 60 mm to 70 mm can achieve the same satisfactory results in cardioversion, and should not be the contraindication of concomitant surgical ablation.