Left Atrial Plication for Left Ventricular Posterior Wall Bending With Atrial Functional Mitral Regurgitation

Left ventricular basal posterior wall (LVbp) inward bending in patients with rheumatic mitral regurgitation and giant left atrium (LA) is a risk for low cardiac output after mitral valve (MV) surgery, which is dramatically improved by aggressive LA plication. However, the effects of LA plication on LVbp bending in patients with atrial functional mitral regurgitation (aFMR) and giant LA have not yet been reported. In 2 patients with LVbp bending, aFMR, and giant LA, MV replacement/repair with aggressive LA plication improved LVbp bending. However, compared to patient 1, in which MV replacement with posterior MV chordal preservation was followed by LA plication, improvements in LVbp bending was greater in patient 2, in which LA plication was followed by MV repair. These findings suggest that aggressive LA plication followed by MV repair has greater benefits (vs MV replacement with posterior MV chordal preservation before LA plication) on LVbp bending in patients with aFMR and giant LA.