Comparison of P-Wave Duration and Dispersion in Mitral Valve Replacement Surgery Via Right Atrial Transseptal or Left Atrial Approach in Rheumatic Mitral Stenosis Patients

Background: Predisposition to atrial fibrillation in mitral valve surgery has been well demonstrated. The changes in electrocardiographic parameters (Pmax, Pmin and P-wave dispersion) related to AF risk are unknown. We aimed to document the relationship between electrocardiographic changes and mitral valve replacement through right or left atrial surgical approaches. Methods: We retrospectively studied 154 patients, who underwent mitral valve replacement surgery from 2008 to 2018. Seventy-nine patients were operated with right atriotomy and transseptal approach (Group 1), and 75 patents were operated with left atriotomy (Group 2). ECGs obtained at hospital admittance and postoperatively at 24 hours were blindly analyzed. Results: Preoperative demographic characteristics were similar. Pmax, Pmin and P-wave dispersion were similar preoperatively. All parameters increased in both groups compared with the preoperative values (P < .05). Postoperative Pmax, Pmin and P-wave dispersion all were statistically significantly higher with the right atrial approach (P < .05). Postoperative AF also was more common in Group 1 (P < .05). Conclusion: Right atrial approach may lead to higher P-wave changes and atrial arrhythmias. This may be due to more extensive surgical disruption. The changes in atrial anatomic structure can increase atrial arrhythmic propensity and can cause atrial fibrillation.

Surgical closure of multiple large apical ventricular septal defects: how we do it

The management of apical ventricular septal defects continues to be challenging because of the difficulty in achieving a complete closure without a left apical ventriculotomy. In this study, we present our innovative technique of closing multiple and/or large muscular apical ventricular septal defects through a right atriotomy. We operated three patients with multiple apical muscular trabecular ventricular septal defects (“Swiss cheese”) using a technique that involved exclusion of the right ventricular apex. Their ages ranged between 2 months and 13 years. The VSDs were approached through right atriotomy. The trans right atrial approach using a 5–0 polypropylene purse-string suture or a two-patch procedure is a novel method of closing large apical ventricular septal defects. It was found to be effective with no persistent residual defects and did not have the disadvantages of a ventriculotomy.