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Surgical Management of Divided Atrial Chambers
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  • Lakshmi Sankhyan,
  • Robert Anderson,
  • Ujjwal Chowdhury,
  • Niwin George,
  • Doniparthi Pradeep,
  • Prateek Vaswani,
  • Niraj Pandey,
  • Balaji Arvind
Lakshmi Sankhyan
All India Institute of Medical Sciences
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Robert Anderson
1Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom Birmingham Children’s Hospital, Birmingham, United Kingdom
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Ujjwal Chowdhury
All India Institute of Medical Sciences
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Niwin George
All India Institute of Medical Sciences
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Doniparthi Pradeep
All India Institute of Medical Sciences
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Prateek Vaswani
All India Institute of Medical Sciences
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Niraj Pandey
All India Institute of Medical Sciences
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Balaji Arvind
All India Institute of Medical Sciences
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Abstract

The morphological variations when one, or both, of the atrial chambers is subdivided, are many and varied. We present a synthesis of 198 published investigations of this “family” of uncommon lesions. Almost three-quarters of patients with divided atrial chambers present during infancy with severe pulmonary hypertension and cardiac failure. Associated cardiac and extra-cardiac defects are present in between half and nine-tenths of cases. Acquired division of the left atrium has been reported after the Fontan operation, orthotopic cardiac transplantation, and complicated aortic valvar infective endocarditis. Surgery under cardiopulmonary bypass remains the definitive treatment. Balloon dilation may be considered in anatomically compatible variants in the setting of cardiac failure and pregnancy as a bridge to definitive treatment. Overall, mortality has been cited between nil to 29%. Presentation during infancy, associated congenital anomalies, pulmonary hypertension, and surgery in the previous era, have been the reported causes of death. The operative survivors have long-term favourable outcomes, with near normal cardiac dimensions and low risk of recurrence. While asymptomatic patients with division of the right atrium do not need treatment, surgical resection of the dividing partition under cardiopulmonary bypass is recommended in symptomatic patients with complex anatomy, the spinnaker malformation, or associated cardiac anomalies. Balloon dilation may be considered in uncomplicated patients with less obstructive lesions. Hybrid intervention and endoscopic robotic correction also have been performed. We submit that an increased appreciation of the anatomic background to division of the atrial chambers will contribute to improved surgical management.

Peer review status:ACCEPTED

13 Jul 2021Submitted to Journal of Cardiac Surgery
14 Jul 2021Assigned to Editor
14 Jul 2021Submission Checks Completed
14 Jul 2021Review(s) Completed, Editorial Evaluation Pending
14 Jul 2021Editorial Decision: Accept