A giant left atrium (LA) may be the result of congenital aneurysms, or chronic atrial fibrillation with thrombi. We present images of a giant LA in a patient with long‐standing rheumatic heart disease.A 72‐year‐old male presented with atrial fibrillation and congestive heart failure 40 years following an open mitral commissurotomy. A chest X‐ray revealed cardiomegaly (Figure A), and a transthoracic echocardiogram showed a giant LA, severe mitral stenosis (mean mitral gradient: 16 mmHg), and moderate tricuspid regurgitation (Figures B–D). A computed tomography scan showed that the LA measured 20.0 × 13.7 cm2 and compressed the left ventricle, right ventricle, and right atrium (Figure E). The patient underwent a mitral valve replacement (size 27 SJM mechanical prosthesis, St. Jude Medical, St. Paul, MN), an LA reduction, and tricuspid valve repair with a MC3 ring (size 30; Edwards Lifesciences, Irvine, CA). The patient tolerated the procedure well and a post‐operative chest x‐ray 6 months following surgery showed a marked reduction in the cardiothoracic ratio (Figure F).A, Chest radiogram showing marked cardiomegaly. B–D, Transthoracic echocardiography showing a giant left atrium associated with severe mitral stenosis and moderate tricuspid regurgitation. E, Computed tomography revealing a giant left atrium with compression of adjacent chambers of the heart.
Journal of Cardiac Surgery – Wiley
Published: Jan 1, 2018
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