Patients with giant left atrium were divided into 2 groups retrospectively. Group 1 comprised 10 patients with compression symptoms who received left atrial plication after mitral valve replacement. Group 2 comprised 31 patients without symptoms of compression who did not receive plication. Age, sex, ejection fraction, and left ventricular end-diastolic pressure were similar in the 2 groups preoperatively. Left atrial diameter reduction was not significantly different between the 2 groups. Mean left atrial diameter was 80.41 ± 15.08 mm preoperatively and 66.64 ± 13 mm postoperatively in group 1. In group 2, the mean values were 80 ± 8.95 and 66.1 ± 8.14 mm, respectively. Postoperatively, no differences were observed in ejection fraction or left ventricular end-diastolic pressure between the 2 groups. Left atrial diameter was over 80 mm in 12 patients in group 2 and it did not reduce postoperatively to below 65 mm in 11 of these patients. On the other hand, only 7 of 19 patients with a left atrial diameter below 80 mm preoperatively did not reduce to values below 65 mm (p = 0.04). Therefore, in cases of giant left atrium with a left atrial diameter below 80 mm, plication might not be necessary.

Two women, aged 19 and 20 years, underwent surgery for hydatid cyst at the right side of the heart. In one patient, the cyst was located on the interventricular septum. It was removed and the defect was closed without capitonnage to avoid blockage. The cavity healed spontaneously. In the other patient, the cyst was at the right atrioventricular groove. It was removed without cardiopulmonary bypass. Both patients recovered well.

During left ventricular ejection, the minor (transverse) axis of the inner wall shortens by 27% to 37%, while the major axis shortens by 9%. Therefore, shortening of the minor axis accounts for 85% to 90% of the stroke volume and the mitral annulus area alters to assist left ventricular contraction. Mitral valve prostheses with large diameters are preferred but these may lead to systolic malfunction by restricting minor-axis shortening. We studied echocardiographic data of patients who has received mechanical mitral valves with the same inner diameter and opening angle but with different outer diameters (29 mm or 31 mm). Although there was no difference preoperatively in ejection fractions in the two groups, the postoperative ejection fraction was significantly higher in patients with the smaller valve. This finding indicates that mitral valve replacement with a prosthesis of large external diameter caused a deterioration in left ventricular function.