Mitral Value Surgery and Left Heart Catheterization in Giant Left Atrium

The finding of a giant left atrium is commonly considered as evidence of predominant mitral regurgitation.* As such, this would contraindicate mitral stenosis surgery. However, in a series of 153 left heart catheterizations we have encountered 14 such patients. In five patients mitral stenosis was the dominant or sole lesion, and surgery was performed in these cases, with confirmation of the preoperative diagnosis. The frequent recording of severe vibratory pressure fluctuations in the left atrium in these patients is of interest in a consideration of the nature of massive left atrial enlargement. Procedures All 14 patients with giant left atrium had a careful history, physical examination, roentgenographic and fluoroscopic evaluation of heart size and chamber enlargement, electrocardiogram, urinalysis, complete blood cell count, and appropriate blood chemistry tests. Transthoracic left heart catheterization was done in the prone position, with intermittent fluoroscopic observation for guidance of needle insertion into the left atrium