Massive left auricle with special reference to its etiology and mechanism

Massive Left Atrium and Mitral Valvotomy

“…The frequency with which massive (aneurysmal) dilatation of the left atrium in rheumatic mitral valve disease is associated with predominant mitral incompetence (Parsonnet et al, 1946;Daly and Franks, 1949) has been a factor against attempting mitral valvotomy in such cases (Baker et al, 1952). The case reported here is of interest in that the physical signs were purely those of mitral stenosis, which was confirmed at and relieved by a subsequent valvotomy.…”

Giant left atrium

“…The left atrium may achieve proportions which have provoked use of descriptive terms such as 'giant', 'massive', or 'aneurysmal'-most often when the mitral valve has been grossly incompetent (Parsonnet, Bernstein, and Martland, 1946), but also with a predominantly or exclusively stenotic valve (Venner, 1954;Kent, Fisher, Ford, and Neville, 1956). Apart from the haemodynamic consequences of a greatly enlarged left atrial chamber, the very size of the chamber constitutes an important disadvantage, with compression and displacement of neighbouring structures.…”

“…These purely anatomical considerations were the subject of most of the earlier descriptions of the lesion, including probably the earliest-by Owen and Fenton (1901). Reference to these earlier descriptions of the lesion are contained in the paper by Parsonnet et al (1946). Daley and Franks (1949) described the clinical features and anatomical consequences-dysphagia from oesophageal displacement, with the oesophagus either grossly stretched and flattened, or compressed against the vertebrae, if it has not slipped to one or other side; splaying of the main bronchi and bronchial compression, sometimes sufficient to obstruct completely a lobar bronchus, especially the left lower and the middle lobar bronchi; interruption of the left recurrent laryngeal nerve; and occasionally even erosion of the spine.…”

Diagnosis of the Mitral Lesion in Patients with Giant Left Atria

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Aneurysmal dilatation of the left atrium occurs in mitral incompetence (Parsonnet, Bernstein, and Martland, 1946) and in mitral stenosis (Venner, 1954), and its presence may mask the underlying mitral lesion by modifying the left atrial pressure pulse (Fairley, 1961) and the indicator-dilution curve (Nixon and Snow, 1962).The purpose of this communication is to describe the important clinical, haemodynamic, and surgical findings in 19 patients with gross enlargement of the left atrium, and to consider the diagnosis of the underlying mitral lesion.

MATERIAL AND METHODSNineteen patients with severe rheumatic mitral valvular disease and gross left atrial enlargement were selected for this study because the mitral valve had been examined at operation. Their ages ranged between 25 and 56 years, and 11 were women.

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“…Aneurysmal dilatation of the left atrium occurs in mitral incompetence (Parsonnet, Bernstein, and Martland, 1946) and in mitral stenosis (Venner, 1954), and its presence may mask the underlying mitral lesion by modifying the left atrial pressure pulse (Fairley, 1961) and the indicator-dilution curve (Nixon and Snow, 1962).…”