Atrium size and Afib.

[wim]

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.

Forum-M.D.-bkj
6/6/2007
wim Wim,

It's impossible to tell you when to operate over the internet. I would need to know exactly the nature of your mitral disease and regurgitation as well as the cause of your aortic disease. With respect to someone who has atrial fibrillation, it is one are of concern in people with mitral regurgitation. The most important criteria involve the function of the ventricle, the presence of symptoms, and the pressures transmitted into the lungs by the regurgitation. Sometimes, we obtain stress echocardiograms to further collect information to help guide us.

Also, with respect to your aortic root it would be important to know more about the aortic valve, the rate the root has grown over time, and whthere there are other conditions such as Marfan's present.

good luck


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 aftere surgery(perhaps to simple).

kind regards

[va_tony]

I also have mitral valve regurgitation (mild), an enlarged atrium (55 mm) and occasional afib (I take rythmol, which keeps me in normal sinus ryhthm most of the time). I don't have any aorta root problems fortunately.

I expect that someday, I'll also need surgery for the mitral valve.  I'm not a doctor but I've done some research on the MVR and afib problems, talking to cardiologists, EPs and reading.  I really don't know much about the aorta enlargement problem.

There was a study done a few years ago at the Mayo Clinic that reached the conclusion that the time to have valve surgery is when your valve regurgitation becomes severe and afib occurs.  It seems you've reached that stage.  So that would indicate you should have surgery.  I would think that a good time to have the aorta surgery is at that time --- two for the price of one so to speak.

If you just have valve/aorta surgery, it's likely you'll still have afib IMO.  An enlarged atrium naturally leads to afib.  Apparently, if there is sufficient surface area, several reentrant wavelets are established simultaneously causing the atria to fibrillate.  So, the atrial area must be reduced in some way.  Usually, during valve surgery the surgeon will also electrically isolate different portions of the atria through a Maze procedure (substrate modification) and also remove the left atrial appendage (which reduces the likelihood of future stroke). That should permanantly cure your afib.  So if you opt for surgery, you should consider having all three procedures at once.

I imagine this must be a difficult decision for you. There are no right or wrong decisions... just probabilities. However, studies show the atrium does increase in size over time if the MVR is not taken care of.  The larger the atrium becomes, the more of a problem with afib you will have.  My MVR is not serious, yet my atrium has increased from 52 to 55 mm over the last five years.  My cardiolgist believes this is due to the afib (at one point I was in continuous afib for about 6 months).

Best wishes for the successful treatment of your heart problems.

Tony