At the age of 55, a giant left atrium (left atrium) measuring 25×20 cm and severe mitral valve disease were diagnosed. During hospitalization, the symptoms (signs of the disease) were pulmonary edema, severe shortness of breath, decreased cardiac output, arrhythmia and extreme fatigue, and weight loss. In order to reduce the size of the giant left atrium (auricle), the patient underwent surgery to separate the heart from the chest and reattach it after the procedure (autotransplantation).
Severe shortness of breath, vaccination
A cardiological examination was performed on the patient who applied to the hospital with complaints of weakness, palpitations and pale skin. Although he had previously lived a completely normal life, he had his examinations performed upon the insistence of his family because these symptoms had increased recently.
In the examinations, it is determined that the heart valve ( Mitral Valve ) is seriously leaking and narrowing, and in addition, the left atrium is extremely enlarged. Atrium enlargement is found to be around 25×20 cm in 2-dimensional measurements, and it has started to press on the surrounding tissues, right atrium, rib cage, and surrounding vessels (Right Atrium, Descending Aorta, LAD, right and left Lung). As a result of the pooling of blood in the giant left atrium, serious pulmonary stasis ( Pulmonary Edema ) has started. The heart has started to not fit into the rib cage.
In the chest films, the heart is at a level that covers the entire rib cage. In the echocardiography findings, the left atrium (auricle) is again prominent and there is serious mitral insufficiency.
Immediately after admission, the surgery strategy was planned and the main purpose of the surgery was to intervene in the Mitral valve and effectively reduce the size of the giant left atrium.
This kind of heart enlargement surgery, which affects all the structures in the rib cage, is performed with the Heart-Lung Machine. The body is completely connected to this device and circulation is temporarily provided through the machine. In this way, the heart and lung functions are temporarily stopped, and all other organs (Brain, Liver, Kidneys, etc.) are protected and even function.
Since the left atrium covers the entire back wall of the heart, it is almost impossible to open it from one side and make an effective surgical reduction. Therefore, the Cardiac Autotransplantation technique was decided. The heart was duly expanded (taken out of the rib cage), and after the necessary procedures such as Atrium Reduction and Mitral Valve Replacement were performed on the table, it was placed back into the rib cage. Since the shrunken heart remained small in the old large heart chamber and its geometry changed, the pericardium was also reduced and its adaptation was ensured. The damage done to other sections by the enlarged heart was also repaired. Since the right atrium remained quite small due to compression, a new right atrium (right atrium) was created with the patient’s pericardium.
After the heart was repositioned, air was removed from it and blood flow was reestablished, the patient who had a rhythm disorder before the surgery returned to normal rhythm. The reason behind this is that since the left atrium and heart were completely removed, it served as a kind of “Ablation” (Box-Lesion). In other words, the heart’s conduction system, which was damaged by the growth, was also restored to normal.
The patient did not develop any postoperative complications. He was discharged with full recovery.
Cardiac autotransplantation, the process of removing the heart and reattaching it in heart surgeries, is among the rarest surgeries. So far, a few cases have been reported due to tumors or heart growth. The information that is spoken among patients that “the heart is removed and reattached in every heart surgery” is incorrect. This procedure is performed on very limited patients and is among the most difficult surgeries. It is stated in the literature that the mortality rate (death rate) of this surgery varies between 25% and 75%. However, since it is a procedure performed in very few cases, the chance of statistical verification is low (Lit 1).
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