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The surgical Maze procedure remains an effective treatment for atrial fibrillation but may result in hemodynamic changes with increased right ventricular pressure (RVSP) and pulmonary hypertension (PH), previously unreported in the literature.
A review of all patients undergoing Maze surgery between 1/1/1999 and 12/31/2004 was performed. All patients had pre- and post-operative (> 3 months after Maze) 2D transthoracic echocardiograms (TTE). An estimated RVSP cutoff ≥ 40 mm Hg on echocardiogram was suggestive of elevated right-sided pressures. Exclusion criteria included congenital heart disease, pre-operative RVSP ≥ 40 mm Hg, and mitral stenosis. Diastolic parameters including left atrial volume index, E/e', and E:A were recorded when available.
Forty-one patients (26 males) with an average age of 63 ± 10 years met inclusion criteria. Median pre-operative ejection fraction was 60%(interquartile (IQ) 55;65) with no change in post-operative ejection fraction of 58% (IQ 52;63). The majority of patients (26/41, 63%) had post-operative RVSP ≥ 40 mm Hg as seen on 150 total post-operative TTEs at a median follow-up time of 1545 days (IQ 610;2339). Median preoperative RVSP was 32 mm Hg (IQ 27;37) with an increase in post-operative RVSP to 41 mm Hg (IQ 33;58). Median pre-operative E/e’ was 14 (IQ 10;18) while post-operative E/e’ increased to 22 (IQ 15;28). In 13 patients, median pre-operative E:A was 1.8 (IQ 1.1;2.4) with an increase to 2.33 (IQ 2.0;3.3) post-operatively. Eight patients underwent further investigation with right heart catheterization. Mean pulmonary artery pressure was 35 ± 7 mm Hg with a mean pulmonary capillary wedge pressure of 19 ± 5 mm Hg and mean v wave of 27 ± 6 mm Hg, indicating left atrial noncompliance.
Surgical Maze can be complicated by elevated right-sided systolic pressures on echocardiogram, often mediated by diastolic abnormalities and left atrial noncompliance. These elevated pressures suggest that pulmonary hypertension may develop secondary to a change in left atrial compliance. Stiff left atrial syndrome may be a significant sequela following surgical Maze procedures and warrants further investigation.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Pulmonary Hypertension: Physiology/Hemodynamics
Abstract Category: 27. Pulmonary Hypertension
Presentation Number: 1164M-153
- 2013 American College of Cardiology Foundation