ObjectiveTo observe the changes of left atrial geometry before and after mitral valve replacement in patients with different types of mitral valve disease and different heart rhythm, and to identify factors determining left atrial remodeling after mitral valve replacement. MethodsA total of 215 consecutive patients of mitral valve replacement in Department of Thoracic and Cardiovascular Surgery of West China Hospital, Sichuan University from January 2003 to March 2008 were selected and followed up for this study. There were 52 male and 163 female patients with their age of 40.58±10.54 years (ranged, 18-67 years). St. Jude Medical mechanical valves were used. According to the type of mitral valve diseases (mitral stenosis (MS) or mitral regurgitation (MR)) and heart rhythm (atrial fibrillation (AF) or sinus rhythm (SR)), patients were divided into 4 groups. There were 54 patients with MS and SR (including 13 male and 41 female patients with their age of 39.31±9.46 years), 56 patients with MS and AF (including 14 male and 42 female patients with their age of 41.12±10.72 years), 52 patients with MR and SR (including 12 male and 40 female patients with their age of 39.71±10.09 years), 53 patients with MR and AF (including 13 male and 40 female patients with their age of 40.19±11.87 years). All patients had routine examinations and echocardiogram preoperatively and two years after surgery. Left atrial anteroposterior diameter (LAD), left atrial area (LAA), left atrial volume (LAV) and left atrial volume index (LAVi) were used to analyze the changes of left atrial geometry. ResultsThere was no in-hospital death. Major postoperative complications included low cardiac output syndrome in 5 patients, pneumonia in 6 patients. LAVi were lower in mitral stenosis patients than that in mitral regurgitation patients (P<0.05), LAVi were lower in patients with sinus rhythm than that in patients with atrial fibrillation (P<0.05). Two years after mitral valve replacement, the extent of left atrial reverse remodeling were significantly greater in mitral regurgitation patients than in mitral stenosis patients (P<0.05), and the extent of left atrial reverse remodeling were significantly greater in patients with sinus rhythm than that in patients with atrial fibrillation (P<0.05). ConclusionsAge, atrial fibrillation, preoperative left atrial volume, mitral regurgitation, left ventricle end-diastolic diameter are important influencing factors of left atrial reverse remodeling after mitral valve replacement.