Striking left atrial enlargement as a consequence of mitral valve disease

A 76-year-old woman was referred to our imaging department for evaluation of known mitral valve stenosis (MVS). The patient had been diagnosed as having MVS for 16 years and underwent balloon dilatation 10 years ago. During follow-up at the outpatient clinic, she refused any further interventional treatment. Recently, she was admitted to our emergency department with an acute myocardial infarction, which was treated by primary percutaneous coronary intervention. Chest X-ray demonstrated a strikingly enlarged heart, mainly due to left atrial dilatation (Panel A). Transthoracic 2D-echocardiography revealed a moderately decreased left ventricular function, MVS with severe mitral valve regurgitation and a dilated left atrium (LA) (Panel B, movie 1). As she also had post-infarction angina pectoris with left main stem disease, CABG and mitral valve replacement were considered. Magnetic resonance imaging (MRI) was performed for pre-operative evaluation and demonstrated a LA of 9×11×15 cm3 (1.5 L), a moderate to severe MVS (area 1.4 cm2), and a severe mitral valve regurgitation with a central jet (Panels C and D, movie 2). Left and right ventricular function was preserved. The patient was referred for CABG, mitral valve replacement, and surgical reduction of the LA. Panel A. Chest X-ray anterior-posterior showing cardiomegaly. Panel B. Transthoracic 2D-echocardiography. Apical four-chamber view. Panel C. Cine MRI in systole. Three-chamber view with aorta (Ao), left ventricle (LV), and LA. Panel D. Cine MRI in diastole. Three-chamber view withAo, LV, and LA.