Enlarged left atrial / valve repair

[BrutisDiogi]

I am a very healthy & active 44 year old female.  I walk several miles daily.  I have always had a healthy life-style.  Never have smoked.  In spite of having very few symptoms I needed to have mitral valve repair in 05 along with a Maze proceedure.  The surgery was very successful & quite a breeze for recovery.  The only symptom I detected was a slight light-headedness intermittently while running.  I had had lots of palpitations & irregular heatbeats for years but never paid much attention to them & was aware I had a heart murmur.  I also have had a dry cough for many years that no one was able to diagnose.  I had a stroke two years ago w/ no lasting effects.  After many tests there was no definitive answer for the cause of the stroke at the time.  The only medication I take is a daily asprin & an occassional Benadryl or Advil.  I just had a heart re-check with the following readings:

LV Diastolic Diameter 5.4cm
LV Systolic Diameter 3cm
LV Fractional Shortening 0.44
IVS Diastoic Thickness 1cm
LVPW Diastolic Thickness 1cm
LA Systolic Diameter 6.3cm
Aortic Root Diameter 3.4cm

"Compared to last echo there appears to be a decrease in LV systolic function.  LVEF is 50-55%"
"Left Atrium:  Markedly enlarged left atrial size"
"Right Atrium:  Enlarged right atrial size"
"peak/mean PG is 4/2mmHg.  There is a mild mitral regurgitation seen by color flow."
"Structurally normal aortic valve.  Mild aortic Insufficiency noted."
"Mild tricuspic regurgitation noted.  Estimated RV systolic pressure 16mmHg."

all else falls within "normal" ranges

Are there any life-style changes I should make to prevent further changes?  Can any of these changes be reversed?  Are there any subtle symptoms I should be aware of that would require medical attention?  What is the prognosis for readings such as this?

Thank you very much for you help.

[Jerry_NJ]

Dody raises a number of good points.

Seem we have three here, my having mitral valve repair in November 2007 and an Maze.  The recovery was uneventful for me, and while I was in intensive care for five days the nurses took great care of me and I had only minimum discomfort...mostly just tired.

My leaky mitral valve caused my left atrial to enlarge to 5.3 cm and was the driving factor for repairing the valve, before the chamber was enlarged further.  Any size over 5 cm, I understand, is problematic as far as curing AFig is concerned, and is clearly the case for me.  

Best I know, if you blood pressure is normal or controlled to normal and you have good valves the heart should not be under any enlargement stress...but I am not sure on this point.

[DodyRosy]

I have had a similar situation except my surgery/recovery was not a breeze. Please read my post from yesterday "flecainide for a-fib and a-flutter."

Why did you have the MAZE - were you having a-fib? Perhaps that is why you had the stroke - sometimes a-fib and a-flutter are silent (especially if your rate is controlled with a beta blocker).

You might look into whether or not you are having a-fib. Sometimes it is hard for them to catch on the halter monitors. The recordable event monitors that you call in do not automatically detect a-fib/a-flutter - please be aware of that. You need a cardionet wireless - that is what picked mine up this week (9 months post op). Otherwise they were considering me a-fib free and the surgery a success.

Was your atria enlarged before (pre and post op)? Mine was due to 39 years of severe mitral regurgitation - that's what caused the arrhythmias. Otherwise I felt great and could do anything - very athletic. My docs spent my entire life watching out for congestive heart failure and they missed all the warning signs for a-fib. Now I am stuck with many complicated arrhythmias even post op. My surgeons at CCF informed me that sometimes the atria does not go back to normal size if it has been enlarged for a long period.

Also there can be a big difference in echo interpretation depending on the tech that performs the echo and the physician reading it. I had echos every six months my adult life and they were all different, sometimes drastically different but the basic diagnosis was the same.