DISCUSSION
Compression of the esophagus by neighboring structures cause dysphagia. However, a massive dilated left atrium is a rarely considered cause of dysphagia, like our case [2].
The most common cause of left atrial enlargement is rheumatologic mitral valve disease. The GLA is used for the 6.5 cm and larger atrium[1]. In their series, El Maghraby[3] et al found the incidence of GLA in rheumatologic valve disease about by 0,6%, which is 11-12 times more common than non-rheumatological valve diseases.
The presence of compression symptoms, thrombus history and thromboembolic events are the indications for atrial reduction[1]. Traditional left atrial reduction surgery performed as; inferior atrial wall partial plication or excision of inferior atrial wall, partial plication or excision of both superior and inferior atrial walls, partial auto-transplantation of the heart. Weakening of the atrial wall due to rheumatologic factors and/or dilatation and increased atrial wall fragility and patients’ comorbidities are likely to increase the risk of the complications in resection surgery [1,3,4]. In the present case, we have preserved anatomic structure and symmetric reduction by providing a decrease in surface areas of the five walls of left atrium.
Possible rheumatologic process leading to pancarditis leads to attenuation of the atrial wall. Also increased atrial pressure causes an increase in atrial wall thickness with a fibrous tissue accumulation mechanism. Fibrosis plays an important role in the development of atrial fibrillation. The atrial reduction surgery decreases the recurrence of atrial fibrillation and improves the success of the ablation procedure[1,3,5,6]. In our case, we observed that the atrium wall became thicker and non-contractile. Chronic atrial fibrillation was not affecting hemodynamics; therefore, we did not perform ablation procedure.
We did not cause a significant increase in the operation time, and we did not encounter any complications in the perioperative postoperative period. We also succeeded in reducing left atrium volume by over 60% and eliminating gastrointestinal and cardiac complaints.