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Heart Disease (Expert Forum)
AF and atriumsize
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AF and atriumsize
by wim, Jun 09, 2007 12:00AM
Hello I live in the netherlands and are interested in your treament strategy.
I Have an MVP cat 3. Left atrium size 53 mm and an enlarged aortaroot of 50 mm (aorta valve is good). Since eastern I have atrium fibrillation some times it is gone most often it is present. I am a male of 53 old 1,86 meter and 85 kg. The AF occured after a cycletour of 100 km. I use sotalol 2 x 40 mg a day.
Dou you think surgery(of the MVP and aorta) is nessecary. Before the occurance of AF my condition was (very) good now I am often tired.
Thanks for this answer.
Your reaction is like the docters in the hospital, some say surgery other think it can wait. The riscs of a growing aorta are well known. But what are the riscs of futher atriumsize increase (now 53 mm). And do you think there is a good chance that my AF will disappear after surgery of the mitral valve. It suddenly came after sportactivities due to MVP so I think it should by gone after surgery(perhaps to simple).
kind regards
I Have an MVP cat 3. Left atrium size 53 mm and an enlarged aortaroot of 50 mm (aorta valve is good). Since eastern I have atrium fibrillation some times it is gone most often it is present. I am a male of 53 old 1,86 meter and 85 kg. The AF occured after a cycletour of 100 km. I use sotalol 2 x 40 mg a day.
Dou you think surgery(of the MVP and aorta) is nessecary. Before the occurance of AF my condition was (very) good now I am often tired.
Thanks for this answer.
Your reaction is like the docters in the hospital, some say surgery other think it can wait. The riscs of a growing aorta are well known. But what are the riscs of futher atriumsize increase (now 53 mm). And do you think there is a good chance that my AF will disappear after surgery of the mitral valve. It suddenly came after sportactivities due to MVP so I think it should by gone after surgery(perhaps to simple).
kind regards
Doctor's Answer
by Forum-M.D.-MJM, Jun 09, 2007 12:00AM
Hello,
Dou you think surgery(of the MVP and aorta) is nessecary.
http://www.acc.org/qualityandscience/clinical/guidelines/valvular/Valvularpocketguide.pdf
I am unfamiliar with your cat 3 MVP but I am going to assume that means that your valve has significant leaking. If it does not have significant leaking, the following answer does not apply. Figure 7 in this pdf document shows our guidelines for when to replace a leaking mitral valve. The first option in the decision tree is do you have symtpoms. If you did a 100 km cycle, my guess is you didn't have symptoms before the atrial fibrillation. New onset atrial fibrillation is a class IIa indication for MV repair if possilbe, otherwise replacement. Class IIa means that there is no randomized controlled trials showing there is a definite benenfit but there is data to suggest that there is a high likelihood of benefit. This is assuming that your heart function is normal or near normal. (use acrobat reader to view it if you are unable to open it -- it is a free download.)
In situations like this it is important to go to a high volume center that has a high success rate with MV repairs. They should also be able to do a maze or equivalent during the surgery.
Regarding the aortic root, I could not find firm guidelines about the size for replacement. In general this is a clinical decision based on the the degree of dilation, whether the valve is bicuspid, and the rate of expansion. 50 mm is enlarged but but itself would not warrant sugery. If MV surgery is indicated, it would likely be replaced at the time of surgery.
But what are the riscs of futher atriumsize increase (now 53 mm).
If you continue to have a leaky valve, it is likely that your atrium will continue to increase in size and that your atrial fibrillation will become more frequent. Time is the only way to know for sure.
And do you think there is a good chance that my AF will disappear after surgery of the mitral valve.
With a maze procedure and fixing the valve, you have a good chance of being free from AF after the surgery -- if you decide to pursue it.
I hope this helps. Good luck.
Dou you think surgery(of the MVP and aorta) is nessecary.
http://www.acc.org/qualityandscience/clinical/guidelines/valvular/Valvularpocketguide.pdf
I am unfamiliar with your cat 3 MVP but I am going to assume that means that your valve has significant leaking. If it does not have significant leaking, the following answer does not apply. Figure 7 in this pdf document shows our guidelines for when to replace a leaking mitral valve. The first option in the decision tree is do you have symtpoms. If you did a 100 km cycle, my guess is you didn't have symptoms before the atrial fibrillation. New onset atrial fibrillation is a class IIa indication for MV repair if possilbe, otherwise replacement. Class IIa means that there is no randomized controlled trials showing there is a definite benenfit but there is data to suggest that there is a high likelihood of benefit. This is assuming that your heart function is normal or near normal. (use acrobat reader to view it if you are unable to open it -- it is a free download.)
In situations like this it is important to go to a high volume center that has a high success rate with MV repairs. They should also be able to do a maze or equivalent during the surgery.
Regarding the aortic root, I could not find firm guidelines about the size for replacement. In general this is a clinical decision based on the the degree of dilation, whether the valve is bicuspid, and the rate of expansion. 50 mm is enlarged but but itself would not warrant sugery. If MV surgery is indicated, it would likely be replaced at the time of surgery.
But what are the riscs of futher atriumsize increase (now 53 mm).
If you continue to have a leaky valve, it is likely that your atrium will continue to increase in size and that your atrial fibrillation will become more frequent. Time is the only way to know for sure.
And do you think there is a good chance that my AF will disappear after surgery of the mitral valve.
With a maze procedure and fixing the valve, you have a good chance of being free from AF after the surgery -- if you decide to pursue it.
I hope this helps. Good luck.
Member Comments (2)
by ValveJob, Jul 04, 2007 12:00AM
I think it is time you see a surgeon and get your mitral valve repaired if possible (replaced if a repair is not possible) and have a Maze Procedure done. I had 4+ regurgitation of my mitral valve and the atrium measured 5.7 cm. I finally developped AF, and in October 2005 I had a mitral valve repair and Maze Procedure. My atrium shrunk the first year to 4.7 c.m, and I am in normal sinus rhythm.
