Giant Left Atrium in Triple Rheumatic Heart Disease


  • Gëzim Berisha
  • Edmond Haliti Medical Faculty, University of Prishtina, Pristina, Kosovo
  • Gani Bajraktari Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo



The giant left atrium (GLA) is a rare condition, commonly associated with rheumatic mitral valve disease, and very rarely with non rheumatic heart disease (nRHD). The triple valvular heart disease with involved mitral, aortic and tricuspid valves is quite uncommon. A 47 year female patient with a past medical history of rheumatic heart disease (RHD) and known severe mitral stenosis was with severe breathlessness (NYHA class IV). She had undergone mitral valve commissurotomy and tricuspid valve annuloplasty 12 years previously.  Transthoracic echocardiography revealed a giant left atrium, moderate to severe mitral valve restenosis, severe mitral regurgitation, moderate aortic regurgitation and severe tricuspid regurgitation, associated with severe secondary pulmonary hypertension and a markedly dilated right heart chambers. The patient was considered inoperable by the heart team, because of advanced pulmonary hypertension predicting a very high risk for open heart surgery. The final treatment decision was a difficult and complex issue.


Oh JK. Echocardiographic evaluation of morphological and hemodynamic significance of giant left atrium. An important lesson. Circulation. 1992: 25: 328-36

Piccoli GP, Massini C, Di Eusanio G, et al. Giant left atrium and mitral valve disease: early and late results of surgical treatment in 40 cases. J Cardiovasc Surg (Torino). 1984; 25: 328-36.

Brambati M, Marletta F, Maninna G, et al. Rheumatic heart disease with triple valve involvement. Signa Vitae. 2014; 9: 50-52. DOI: 10.22514/SV91.042014.9.

Seckeler MD, R Hoke TR. The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol. 2011; 3: 67–84. doi: 10.2147/CLEP.S12977.

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016 May 20. doi: 10.1002/ejhf.

Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003; 24: 1231–1243.

Nkomo VT, Gardin JM, Skelton TN, Burden of valvular heart diseases: a population-based study. Lancet 2006; 368: 1005–1011. DOI: 10.1016/S0140-6736(06)69208-8

Mirabel M, Lung B, Baron G, et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J. 2007; 28: 1358–1365. DOI: 10.1093/eurheartj/ehm001.

Solomon SD, Rizkala AR, Gong J, et al. Angiotensin Receptor Neprilysin Inhibition in Heart Failure With Preserved Ejection Fraction: Rationale and Design of the PARAGON-HF Trial. JACC Heart Fail. 2017 Jul;5(7):471-482. doi: 10.1016/j.jchf.2017.04.013.

Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal 2015;2:2 DOI: 10.17987/icfj.v2i1.4






Letters to the Editor