Key result
Prompt mechanical circulatory support followed by aortic and mitral valve replacement successfully treated a 70-year-old man presenting with acute decompensated heart failure and giant cardiomegaly (CTR ≥ 0.80).
Why the study?
Extreme cardiomegaly with a cardiothoracic ratio exceeding 0.80 is exceptionally uncommon and typically associated with advanced chronic valvular heart disease.
Case Report (n=1)
No
This case demonstrates that successful surgical management and recovery are possible in patients with extreme cardiomegaly (CTR ≥ 0.80) and multivalvular heart disease when timely mechanical circulatory support and valve replacement are employed.
Should not yet change practice in extreme cardiomegaly; leaves open whether timely MCS plus multi-valve surgery generalizes beyond this case.
Cardiomegaly, particularly in its extreme form, is a rare but clinically significant manifestation of chronic valvular heart disease. While a cardiothoracic ratio (CTR) greater than 0.50 indicates cardiac enlargement, a CTR exceeding 0.80 is exceptionally uncommon and typically associated with advanced disease. We report the case of a 70-year-old man with severe aortic and mitral stenosis who developed acute decompensated heart failure (HF) and exhibited profound cardiomegaly (CTR ≥ 0.80). We initiated intervention upon the patient's presentation to the emergency department and closely followed his clinical progression through surgery and subsequent recovery until discharge from the ward. The patient required mechanical circulatory support, including an intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO), followed by successful aortic and mitral valve replacement, as well as tricuspid annuloplasty. Despite postoperative hemodynamic instability requiring delayed sternal closure, the patient was ultimately weaned off support and discharged in stable condition. This case underscores the prognostic value of CTR as a non-invasive marker of cardiac remodeling and highlights the potential for recovery in even extreme anatomical presentations when timely and aggressive interventions are undertaken.
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Chen et al. (2025) conducted a case report in Giant cardiomegaly and multivalvular heart disease (n=1). Mechanical circulatory support and valve replacement surgery was evaluated on Clinical recovery and hospital discharge. Prompt mechanical circulatory support followed by aortic and mitral valve replacement successfully treated a 70-year-old man presenting with acute decompensated heart failure and giant cardiomegaly (CTR ≥ 0.80).
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