OBJECTIVE: This study aimed to evaluate blood flow stagnation in an enlarged left atrium (LA) and prove that left atrial plication (LAP) could alleviate the stagnation.
METHODS: Five patients with chronic atrial fibrillation who underwent mitral valve surgery followed by LAP for an enlarged LA with a ≥ 60-mm diameter were included. We performed computational fluid dynamics (CFD) analysis using preoperative and postoperative computed tomography and four-dimensional flow magnetic resonance imaging. Additionally, computer graphics were used to create virtual left atrial appendage resection (LAAR) images. We performed CFD analysis to assess blood flow stagnation in the LA for three groups: preoperative, LAAR, and LAP.
RESULTS: When the average and constant stagnation volumes were both set to 100 preoperatively, the average stagnation volumes of the LAAR and LAP groups were 67.42 ± 18.64 and 35.88 ± 8.20, respectively. The constant stagnation volumes of these groups reduced to 45.01 ± 7.43 and 21.14 ± 7.70, respectively. The LAP group also had significantly lower average and constant stagnation volumes than those in the LAAR group (p = 0.006 and p = 0.033, respectively).
CONCLUSIONS: Blood flow stagnation was noted in the LAA and enlarged LA. CFD analysis revealed that LAP for the enlarged LA improved blood flow stagnation more than the virtual LAAR alone.
BACKGROUND: UMIN000049923.

OBJECTIVE: The aim of this study was to determine the effect of oral sodium bicarbonate solution on delivery outcome of primiparous women with labor stagnation.
METHODS: This randomized controlled trial study was performed on 142 primiparous pregnant women referred to Jiroft University hospitals who had stagnation during labor. In the intervention group, in addition to oxytocin, 4.26 g of sodium bicarbonate dissolved in 200 mL of water were given orally. The control group received only oxytocin. Data were analyzed by t-test and chi-square test.
RESULTS: The mean interval of dilatation stopping to delivery in the intervention group was significantly lower than the control group (202.34 vs 304.08 min, P = 0.001). The mean duration of the first and second stages of labor in the intervention group was lower than the control group (280.44 vs 397.16 and 35.00 vs 51.72 min respectively, P = 0.001). There was no statistically significant difference between the intervention and control groups in the rate of cesarean section and Apgar score. In the intervention group, the rate of spontaneous delivery was significantly higher (65 vs 56 cases, P = 0.03) than the control group.
CONCLUSIONS: The results of the present study could suggest the use of oral bicarbonate in stagnation as a cheap and no-cost method to facilitate normal vaginal delivery.