The effect of the cryosurgical cox-maze procedure on pulmonary veins diameter and left atrial size: Computed tomography angiographic assessment

Jacob Sosna, Niv Ad*, Naama R. Bogot, Dorith Shaham, Philip M. Berman, Amir Elami

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: The Cox-Maze procedure using cryoablation results in transmural lesions, which follow the lesion pattern of the cut-and-sew Cox-Maze procedure. The purpose of our study was to evaluate the effect of the Cox-Maze procedure on left atrial and pulmonary vein size using computed tomography angiogram (CTA). An additional aim was to evaluate pulmonary vein anatomic variability. Methods: Six patients (four women and two men; ages 39-63 years, mean age 54.3) underwent chest CTA 1 day before and 38 to 104 days (mean 62.6 days) after the cryosurgical Cox-Maze procedure. Measurements of pulmonary vein ostia and left atrial cranio-caudal, left-to-right and anterior-posterior diameters were derived by consensus. The change in diameters after therapy was compared using the Wilcoxon nonparametric test for paired measurements. Four patients (1 woman and 3 men; age 57-73 years; mean age 59) were evaluated with postoperative CTA alone 296-530 days (mean 447) after surgery, for the development of postoperative pulmonary vein stenosis. A single patient underwent preoperative CTA, but surgery was not performed. Pulmonary venous anatomy was recorded in all 11 patients. Results: Sinus rhythm was restored in all operated patients. No focal ostial stenosis of the pulmonary veins was observed. The quantitative assessment in the six patients with preoperative and postoperative studies disclosed only slight changes in pulmonary vein diameter with either reduction or dilatation of no more than 20% from baseline (P > 0.05). There was a consistent trend toward decrease in left atrial dimensions, which did not reach statistical significance. Six patients (55%) had standard pulmonary venous anatomy and five patients (45%) had at least one variation in their pulmonary vein anatomy. Conclusions: In this study, we found that a very intensive cryoab-lation protocol around the pulmonary veins did not result in pulmonary vein stenosis. In addition, a relatively high incidence of anatomic variations of the pulmonary veins was documented.

Original languageAmerican English
Pages (from-to)209-216
Number of pages8
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Issue number4
StatePublished - 2009
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the Ministry of Information of the Russian Federation (RT-22 radio telescope; registration no. 01-10) and the Russian Foundation for Basic Research (project no. 99-02-16293). We are grateful to the staff of the Pushchino Radio Astronomy Observatory for help with the observations.


  • Atrial fibrillation
  • Cryosurgery
  • Maze procedure
  • Pulmonary veins


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