Symptomatic pulmonary hypertension with giant left atrial v waves after surgical maze procedures: Evaluation by comprehensive hemodynamic catheterization

Terrence D. Welch, Megan Coylewright, Brian D. Powell, Samuel J. Asirvatham, Bernard J. Gersh, Joseph A. Dearani, Rick A. Nishimura

Research output: Contribution to journalArticle

14 Scopus citations


Background The surgical maze procedure is highly effective in treating symptomatic atrial fibrillation but may have detrimental effects on left atrial (LA) contractile function and compliance. Objective To describe a series of patients presenting with symptomatic pulmonary hypertension due in part to LA dysfunction after surgical maze procedures. Methods This report includes 9 patients who (1) presented to Mayo Clinic (Rochester, MN) between 2008 and 2012 with unexplained dyspnea and pulmonary hypertension after the surgical maze procedure, (2) underwent comprehensive hemodynamic catheterization with transseptal measurement of LA pressure, (3) had large v waves on LA pressure waveforms, and (4) did not have significant mitral valve regurgitation or stenosis or pulmonary vein stenosis. Results Invasive hemodynamic assessment revealed (1) severe pulmonary hypertension (mean pulmonary pressure 47 ± 6 mm Hg), (2) severe LA hypertension (27 ± 4 mm Hg), (3) giant LA v waves (to 50 ± 8 mm Hg), (4) absence of LA or left ventricular a waves, and (5) blunted x descents (2 ± 1 mm Hg). Left ventricular end-diastolic pressure was also elevated (20 ± 5 mm Hg). CONCLUSIONS Abnormalities in LA compliance and contractility may lead to giant LA v waves and symptomatic pulmonary hypertension after surgical maze procedures. This syndrome should be considered in the differential diagnosis for pulmonary hypertension and underscores the importance of comprehensive hemodynamic catheterization.

Original languageEnglish (US)
Pages (from-to)1839-1842
Number of pages4
JournalHeart rhythm
Issue number12
StatePublished - Dec 1 2013



  • Ablation
  • Atrial fibrillation
  • Heart failure
  • Hemodynamics
  • Left atrial function
  • Pulmonary hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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