Giant left atrium: a review

Abstract

Giant left atrium is a rare condition, with a reported incidence of 0.3%, and following mainly rheumatic mitral valve disease. Although rheumatic heart disease represents the main cause of giant left atrium, other etiologies have been reported. Giant left atrium has significant hemodynamic effects and requires specific management. In this review, we present two cases, discuss the different definitions, etiologies, clinical presentation and management modalities.

Keywords: Atrial fibrillation; atrial plication; compression; giant left atrium; maze procedure; rheumatic heart disease.

Figure 1

(a) The chest X-ray AP view showed increased cardiothoracic ratio; the left atrial shadow extended towards the left and right cardiac borders, with bilateral lung haziness. The mitral prothesis is visualized. (b) Transthoracic echocardiography in parasternal long axis view showed the proshtetic mitral valve and a markedly dilated left atrium measuring 10.8 cm

Figure 2

Pre-operative images. (a) The chest X-ray AP view showed increased cardiothoracic ratio, the left atrial shadow is shifted towards the right sternal border with splaying and lifting of the carina as well as the right and left bronchus. (b) Transthoracic echocardiography in parasternal long axis view, revealed a markedly dilated left atrium measuring 12.1 cm with severe mitral stenosis

Figure 3

Post-operative images. (a) the chest X-ray AP view and (b) TTE showed mitral prothesis. The dilated left atrium decreased to 10 cm by TTE measurement

Figure 4

Anatomical specimen showing the left atrium seen from the posterior aspect and the relations to the main, left and right bronchus, the pulmonary veins, systemic veins and both lungs after removal of the esophagus. (Extracted from Gray's Anatomy 20^th edition)