Giant Left Atrium in Rheumatic Heart Disease

Plaschkes, J.; Borman, Joseph B.; Merin, Gideon; Milwidsky, H.

doi:10.1097/00000658-197108000-00004

Cited by 35 publications

(13 citation statements)

References 9 publications

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“…In addition to the classic concept of long-standing pressure or volume overload, direct rheumatic involvement 14) 15) in the left atrium would provide a structural substrate for excessive LA enlargement, sometimes called LA aneurysm. Previous studies showed that pathologic changes of the left atrium differed between RHD and non-RHD groups; there was a higher prevalence of fibrosis, post-inflammatory changes, Aschoff body, and higher expression of inflammatory markers in the RHD group than the non-RHD group.…”

Section: Discussionmentioning

confidence: 99%

Associates and Prognosis of Giant Left Atrium; Single Center Experience

Kim

Park

Choi

et al. 2017

J Cardiovasc Ultrasound

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BackgroundLeft atrial (LA) remodeling develops as a result of longstanding pressure overload. However, determinants and clinical outcome of excessive remodeling, so called giant left atrium (GLA), are not clear.MethodsClinical characteristics of patients with GLA (antero-posterior diameter higher than 65 mm), including echo-Doppler parameters, and follow-up clinical outcomes from a tertiary referral hospital were investigated.ResultsAmong 68519 consecutive primary patients who underwent echocardiography over a period of 10 years, data from 163 GLA cases (0.24%) were analyzed. Main causes were significant rheumatic mitral stenosis (n = 58, 36%); other causes comprised significant rheumatic mitral regurgitation (MR; n = 10, 6%), mitral valve (MV) prolapse or congenital mitral valvular disease (MVD) (n = 20, 12%), and functional MR (n = 25, 15%). However, mild rheumatic MV disease (n = 4, 3%) or left ventricular (LV) systolic or diastolic dysfunction without significant MR (n = 46, 28%) were also causes of GLA. During median follow-up of 22 months, 42 cases (26%) underwent composite events. MV surgery was related to lower rate of composite events. In multivariate analysis, MV surgery, elevated pulmonary arterial systolic pressure, and increased LA volume index were independent predictors of future events (p < 0.05) regardless of underlying diseases or history of MV surgery.ConclusionAlthough rheumatic MVD with atrial fibrillation is the main contributor to GLA, longstanding atrial fibrillation with LV dysfunction but without MVD also could be related to GLA. Even in GLA state, accurate measurement of LA volume is crucial for risk stratification for future events, regardless of underlying disease.

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Section: Discussionmentioning

confidence: 99%

Associates and Prognosis of Giant Left Atrium; Single Center Experience

Kim

Park

Choi

et al. 2017

J Cardiovasc Ultrasound

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“…Such an enlargement is beneficial as it reduces pulmonary congestion, thus it protects the lung from pulmonary hypertension and oedema [4]. However, with gradual increase in left atrial pressure an associated increase in pulmonary venous pressure will eventually occur [2]. …”

Section: Discussionmentioning

confidence: 99%

“…The condition has been closely related to rheumatic mitral valve regurgitation or mixed mitral valve disease causing severe pressure and volume overload [1]. However, the condition can be associated with mitral valve prolapse, heart failure, chronic atrial fibrillation and left to right shunt [2,3,5]. Rarely, it can be seen in patients with normal mitral valve function [2].…”

Section: Discussionmentioning

confidence: 99%

“…However, the condition can be associated with mitral valve prolapse, heart failure, chronic atrial fibrillation and left to right shunt [2,3,5]. Rarely, it can be seen in patients with normal mitral valve function [2]. …”

Section: Discussionmentioning

confidence: 99%

“…The exact etiology is not known. Both increased left atrial pressure and weakening of left atrial wall by rheumatic pancarditis are implicated in its development [1,2]. …”

Section: Introductionmentioning

confidence: 99%

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Giant left atrium associated with massive thrombus formation

Darwazah

Sayed

2013

Thrombosis Journal

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Giant left atrium is a condition characterized by huge enlargement of the left atrium with a diameter exceeding 65mm. It is most commonly associated with long standing rheumatic mitral valve disease. We present a 45-year-old female patient with rheumatic mitral stenosis associated with giant left atrium occupied by an 11 × 10 × 5 cm thrombus weighing 500 gms. The patient underwent successful mitral valve replacement and thrombectomy through an inverted T-shaped biatrial incision.

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