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Extrinsic compression of the left main coronary artery (LMCA) by a dilated pulmonary artery (PA) in the setting of pulmonary arterial hypertension (PAH) is an increasingly recognized disease entity. LMCA compression has been associated with angina, arrhythmia, heart failure, and sudden cardiac death in patients with PAH. Recent studies suggest that at least 6% of patients with PAH have significant LMCA compression. Screening for LMCA compression can be achieved with computed coronary tomography angiography, with a particular emphasis on assessment of PA size and any associated downward displacement and reduced takeoff angle of the LMCA. Indeed, evidence of a dilated PA (>40 mm), a reduced LMCA takeoff angle (

Objective To determine whether the etiology of mitral valve disease (MVD), due to either rheumatic or degenerative pathology, influences long-term outcomes after the Cox-Maze IV procedure (CMPIV). Methods Between February 2001 and July 2015, 245 patients received a CMIV and concomitant mitral valve procedure. Patients were separated into 2 cohorts based on their etiology of MVD, degenerative (n = 153) and rheumatic (n = 92). Patients were followed prospectively (mean follow-up: 41 ± 37 months) for recurrent atrial tachyarrhythmias (ATAs). Perioperative variables and long-term freedom from ATAs on and off antiarrhythmic drugs (AADs) were analyzed retrospectively. Results The 2 groups differed in that patients with rheumatic MVD were younger, more likely female, had a larger preoperative left atrial diameter, a longer duration of atrial fibrillation (AF), a greater percentage of longstanding persistent AF, and worse New York Heart Association functional class ( P ≤ .001). Although there was no difference in operative mortality or overall major complications between the groups, the median length of stay in the intensive care unit was longer in the rheumatic cohort. Freedom from recurrent ATAs through 5 years was similar between the 2 cohorts. Predictors of recurrence included failure to use a box-lesion ( P = .012), the duration of preoperative AF ( P = .001), and early occurrence of ATAs ( P = .015). Conclusions The long-term efficacy of the CMPIV in restoring sinus rhythm was similar in patients with either rheumatic or degenerative mitral valve disease. Despite representing a sicker patient population with a longer duration of preoperative AF, patients with rheumatic MVD equally benefit from the CMPIV.