Key result
A 60-year-old male with a mechanical mitral valve developed a cerebrovascular accident and was found to have an extremely rare giant left atrium measuring 12.4 cm in diameter and 2000 cc in volume.
Why the study?
An extremely dilated left atrium is a very rare condition that increases the risk for ischemic cerebrovascular accidents due to blood stasis, but is rarely reported in the literature.
Case Report (n=1)
A rare case of a giant left atrium (volume 2000 cc) in a patient with a mechanical mitral valve who developed an ischemic stroke despite anticoagulation, highlighting the potential need for higher INR targets and dual pathway inhibition in such extreme cases.
Giant left atrium may contribute to stroke despite anticoagulation in mechanical valve patients; leaves open whether intensified antithrombotic strategies warrant study.
Left atrium enlargement is very common in patients with valvular heart disease and atrial fibrillation but an extremely dilated left atrium is a very rare condition and rarely reported in the literature. It is a risk factor for ischemic cerebrovascular accidents due to blood stasis as the cavity diameter increases. We are reporting a case of rarely seen severely dilated left atrium with a normal functioning prosthetic mechanical mitral valve with a cerebrovascular accident on anti-vitamin K and aspirin. The patient had a left atrium diameter of 12.7 cm, an area of 200 cm square, and a volume of 2000 cc. We elected to keep the international normalized ratio (INR) slightly above the therapeutic range in order to decrease the risk of ischemic events. It might be necessary to do the same for patients with a similar condition to decrease the stroke rates.
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Khoury et al. (2021) conducted a case report in Giant left atrium and cerebrovascular accident (n=1). Giant left atrium was evaluated. A 60-year-old male with a mechanical mitral valve developed a cerebrovascular accident and was found to have an extremely rare giant left atrium measuring 12.4 cm in diameter and 2000 cc in volume.
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