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Giant Left Atrium as Cause of Left Pulmonary Artery Obstruction

1987; Elsevier BV; Volume: 43; Issue: 3 Linguagem: Inglês

10.1016/s0003-4975(10)60626-1

1552-6259

A.Jorge Serra, Kathleen W. McNicholas, Gerald M. Lemole,

Cardiac tumors and thrombi

A case of a giant left atrium with compression of the left pulmonary artery and left main bronchus is described.The surgical approach was through a left thoracotomy, and the correction included mitral valve replacement, reduction atrioplasty, and dissection and release of the left pulmonary artery.Giant left atrium is a rare entity associated with mitral valve disease.It is usually defined by radiographic [l-31 or echocardiographic (41 criteria.Its exact pathophysiology is unclear [2].When present it may be associated with symptomatic compression of surrounding structures, and surgical management must be individualized.A 12-year-old Liberian girl had had a pulsatile mass in her subxiphoid area since early childhood.During the year before her hospitalization, she noted progressive d p p n e a on exertion and tachycardia, requiring several admissions to a regional hospital.On admission she was receiving digoxin (0.25 mg daily) and quinidine (100 mg, three times daily).She was tall (140 cm) and slender (30 kg), and at the time of physical examination was in no acute distress and had no clubbing or cyanosis at rest.Her pulse was irregular, at a rate of 90 beats per minute.She was afebrile, and her respiratory rate was 28 breaths per minute.There was a palpable thrill at the apex and subxiphoid area and a Grade IV/VI systolic apical murmur radiating to the axilla and back.A mid-diastolic murmur was present, and the second cardiac sound was loud and single.The abdomen was soft, and the liver was palpable 2 cm below the right costal margin.There was a 6-cm-diameter, non-tender, pulsatile mass in the subxiphoid area.Chest roentgenograms showed marked cardiomegaly; the left atrium formed both cardiac borders and touched the left chest wall.There was elevation and posterior displacement of the left main bronchus, which appeared narrowed, and a suggestion of atelectasis of the lingula.There was diminished pulmonary vascularity on the left (Fig 1).The electrocardiogram showed atrial fibrillation and left ventricular hypertrophy.A two-dimensional echocardiogram showed a thickened and prolapsed mitral valve and severe regurgitation.The left atrium was