Results of surgical correction of gigantic left atrium

Abstract

We presented a clinical case of surgical treatment of gigantic left atrium in longstanding mitral regurgitation due to mitral valve disease diagnosed 23 years ago (patient refused surgery and was on medical treatment) and complicated by atrial fibrillation. The patient was referred for surgery with complaints on severe dyspnea on minimal exertion, weakness, fatigue, palpitations and massive leg edema. Diagnosis was established using electrocardiography, chest X-Ray, transthoracic and transesophageal echocardiography, and computed tomography. The patient underwent mitral valve replacement, tricuspid valve annuloplasty and left atrial reduction surgery (atrioplasty by Kawazoe). After surgery, left atrial volume decreased from 813 ml to 294 ml and antero-posterior size from 11.2 to 6.2 cm. The patient was discharged on 8th day after surgery. Control examinations after 6 months and 1 year showed reduction of left atrial volume (319 ml and 294 ml); patient feels well and has no complaints. Thus, our case demonstrated reduction of left atrium early in postoperative period and its slow reduction after surgery during 1 year. It is also showed human reserve capacity and possibility of left atrial dilatation to such sizes. Late diagnosis of such changes in heart is possibly related to the fact that patient was afraid to see doctors and undergo surgery. The left atrial cavity size determination can be done intraoperatively using method of surgical glove we suggested.