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Huge Left Atrium Accompanied by Normally Functioning Prosthetic Valve.

Sabzi F - J Tehran Heart Cent (2015)

Bottom Line: Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation.Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain.Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve.

View Article: PubMed Central - PubMed

Affiliation: Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.

ABSTRACT
Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm) reported thus far in adults with a normal prosthetic mitral valve function.

No MeSH data available.


Related in: MedlinePlus

Echocardiography in the four-chamber view, showing a gigantic left atrium (arrows)
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Figure 2: Echocardiography in the four-chamber view, showing a gigantic left atrium (arrows)

Mentions: A 46-year-old woman with a past medical history of rheumatic heart disease, mitral valve replacement, and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. She was referred by a cardiologist from rural areas and, despite persistent symptoms, she had not seen a physician for many years. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, symptoms of progressive heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. She had undergone the Bjork-Shiley mitral valve prosthesis replacement for severe mitral stenosis when she was 21 years old, in 1987. In the Emergency Ward, a plain chest X-ray study showed a marked cardiomegaly and nearly complete opacification of the lower, middle, and upper lung fields (Figure 1). She suffered from voice hoarseness, but there were no complaints of dysphagia or any other gastrointestinal symptoms. Blood gas analysis was normal. An electrocardiogram demonstrated severe right ventricular hypertrophy and atrial fibrillation. Transthoracic echocardiographic examinations in four chamber view (Figure 2) revealed a moderate decrease of systolic function and severe regurgitation of the tricuspid valve. This examination also unexpectedly demonstrated a massively enlarged LA with a maximum diameter of 20 cm and a transverse diameter of 21 cm with huge thrombosis, marked enlargement of the right ventricles, and severe dilatation of the pulmonary artery, superior vena cava, inferior vena cava, and pulmonary artery. There was also evidence of dilated right-side heart chambers, severe tricuspid valve regurgitation, and pulmonary artery systolic pressure of 100 mmHg. Laboratory examinations revealed abnormal renal function (creatinine > 2.5 mg/dl), abnormal liver function (alanine transferase > 300U), and iron deficiency anemia (hemoglobin = 10 mg/dl). No evidence of active rheumatic disease was documented. The ultrasound study of the abdomen showed congestive hepatomegaly with ascites.


Huge Left Atrium Accompanied by Normally Functioning Prosthetic Valve.

Sabzi F - J Tehran Heart Cent (2015)

Echocardiography in the four-chamber view, showing a gigantic left atrium (arrows)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494521&req=5

Figure 2: Echocardiography in the four-chamber view, showing a gigantic left atrium (arrows)
Mentions: A 46-year-old woman with a past medical history of rheumatic heart disease, mitral valve replacement, and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. She was referred by a cardiologist from rural areas and, despite persistent symptoms, she had not seen a physician for many years. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, symptoms of progressive heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. She had undergone the Bjork-Shiley mitral valve prosthesis replacement for severe mitral stenosis when she was 21 years old, in 1987. In the Emergency Ward, a plain chest X-ray study showed a marked cardiomegaly and nearly complete opacification of the lower, middle, and upper lung fields (Figure 1). She suffered from voice hoarseness, but there were no complaints of dysphagia or any other gastrointestinal symptoms. Blood gas analysis was normal. An electrocardiogram demonstrated severe right ventricular hypertrophy and atrial fibrillation. Transthoracic echocardiographic examinations in four chamber view (Figure 2) revealed a moderate decrease of systolic function and severe regurgitation of the tricuspid valve. This examination also unexpectedly demonstrated a massively enlarged LA with a maximum diameter of 20 cm and a transverse diameter of 21 cm with huge thrombosis, marked enlargement of the right ventricles, and severe dilatation of the pulmonary artery, superior vena cava, inferior vena cava, and pulmonary artery. There was also evidence of dilated right-side heart chambers, severe tricuspid valve regurgitation, and pulmonary artery systolic pressure of 100 mmHg. Laboratory examinations revealed abnormal renal function (creatinine > 2.5 mg/dl), abnormal liver function (alanine transferase > 300U), and iron deficiency anemia (hemoglobin = 10 mg/dl). No evidence of active rheumatic disease was documented. The ultrasound study of the abdomen showed congestive hepatomegaly with ascites.

Bottom Line: Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation.Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain.Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve.

View Article: PubMed Central - PubMed

Affiliation: Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.

ABSTRACT
Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm) reported thus far in adults with a normal prosthetic mitral valve function.

No MeSH data available.


Related in: MedlinePlus