Key result
Severe rheumatic MS and TR present with giant left and right atria.
Case Report (n=1)
This case illustrates the severe multivalvular and structural consequences, including giant atria, of rheumatic heart disease.
Prompts consideration of rheumatic etiology in young adults with severe multivalvular disease; extends sparse case reports but leaves management questions open.
A 19-year-old man presented with New York Heart Association class II heart failure with a history of rheumatic fever in childhood. He was on regular penicillin prophylaxis, diuretics, vasodilators and β blockers. On examination there was grade IV/VI pansystolic murmur at the apex radiating to the axilla, grade III/VI pansystolic murmur at left sternal border fourth intercostal space (increasing on inspiration). Mean jugular venous pressure was elevated (prominent v waves) with gross pedal oedema. A 12-lead ECG revealed atrial fibrillation with a controlled ventricular rate. A transthoracic echocardiogram revealed severe mitral stenosis (videos 1 and 2), moderate mitral regurgitation (video 3), severe torrential tricuspid regurgitation (video 4) and mild aortic regurgitation (video 5).There was severe right ventricular dysfunction with adequate left …
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Mahla et al. (2013) conducted a case report in Rheumatic heart disease (n=1). A 19-year-old man with a history of rheumatic fever presented with severe mitral stenosis, severe tricuspid regurgitation, and giant left and right atria.
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