The treatment of atrial flutter in patients without structural heart disease by transcatheter radiofrequency ablation of the cavotricuspid isthmus and bilateral pulmonary veins has achieved good results. We report three cases of typical atrial flutter treated by surgical radiofrequency ablation. One patient, without structural heart disease, successfully underwent cavotricuspid isthmus ablation and cardioversion. The other two patients, with structural heart disease, underwent cavotricuspid isthmus ablation, partial right atrial ablation and pulmonary vein isolation, but a normal sinus rhythm was not achieved. Therefore, standard maze IV surgery may be the best choice in patients with atrial flutter and structural heart disease.

We report a case of a patient with Marfan syndrome who underwent the David operation and mitral valvuloplasty. The patient had a small left atrium, so we severed the superior vena cava and opened the interatrial groove and left atrial dome. This method allows for excellent exposure of the mitral valve and subvalvular apparatus, enabling a successful operation. The interatrial groove-left atrial dome approach provides an option for patients with a small left atrium undergoing mitral valve surgery.