Progressive Giant Left Atrium After Valve Surgery With Preserved Hemodynamics

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Giant left atrium (n=1). Intervention: Clinical observation of giant left atrium. Primary outcome: Clinical stability and hemodynamic preservation despite progressive left atrial enlargement.

Q: What does this research mean for the field?

Progressive giant left atrium enlargement after valve surgery can remain compatible with prolonged survival when left ventricular function and normal pulmonary hemodynamics are preserved. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Giulia Agostini; Marco Pocar; Matteo Marro; Luca Deorsola; Massimo Boffini; Antonio Loforte; Mauro Rinaldi

doi:10.1016/j.jaccas.2026.110242

September 5, 2026JACC Case ReportsOpen Access

Progressive Giant Left Atrium After Valve Surgery With Preserved Hemodynamics

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Key result

Extreme giant left atrium enlargement to ~1,172 mL/m2 permits long-term survival with preserved hemodynamics.

n=1

Why the study?

Giant left atrium may continue to enlarge despite successful valve surgery, with unclear implications for pulmonary hemodynamics and ventricular function.

Key Points

To describe the long-term clinical and hemodynamic course of extreme progressive left atrial enlargement after surgical correction of rheumatic valvular disease.
Evaluated a 69-year-old man with rheumatic heart disease and previous mechanical aortic and mitral valve replacements over 2 decades of follow-up.
Assessed cardiac structure and function using multimodality imaging, including serial echocardiography and contrast-enhanced chest computed tomography.
Measured invasive pulmonary and intracardiac pressures using right heart catheterization.
Indexed left atrial volume progressively increased over 2 decades from 350 to 702 to 1,172 mL/m2, with left atrial anteroposterior diameter exceeding 8 cm and a cardiothoracic ratio of approximately 0.9.
Right heart catheterization confirmed normal hemodynamics, showing a mean pulmonary artery pressure of 17 mm Hg, pulmonary capillary wedge pressure of 11 mm Hg, central venous pressure of 8 mm Hg, and cardiac output of 5.8 L/min.
Left ventricular ejection fraction remained preserved and the patient maintained clinical stability at NYHA functional class II to III without undergoing high-risk surgical atrial volume reduction.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 69-year-old man with rheumatic heart disease and previous double valve replacement followed for 20 years who developed progressive extreme giant left atrium.

E

Exposure

Redo aortic valve replacement via resternotomy with a 21-mm St Jude mechanical aortic prosthesis, followed by regular cardiological follow-up including multimodality imaging and right heart catheterization.

O

Outcome

Clinical stability, ventricular function, and pulmonary hemodynamics over long-term follow-up.

Progressive extreme giant left atrium can remain compatible with prolonged survival and clinical stability after valve surgery as long as ventricular function and pulmonary hemodynamics remain preserved.

Limitations

Single case report
Mechanisms for preserved normal pulmonary hemodynamics remain speculative and require further investigation

Implication

Preserved hemodynamics may permit long-term survival despite extreme giant left atrium post-valve surgery; leaves open optimal surveillance thresholds in progressive cases.

Abstract

BACKGROUND: Giant left atrium (GLA) is a rare complication of rheumatic heart disease that may continue to enlarge despite successful valve surgery. CASE SUMMARY: ), mediastinal displacement, and pulmonary compression. Despite these findings, right heart catheterization confirmed normal pulmonary artery and filling pressures, with preserved left ventricular ejection fraction and sustained clinical stability. DISCUSSION: GLA is typically associated with pulmonary hypertension and heart failure progression. This case is notable for extreme progressive atrial remodeling over 2 decades despite correction of the underlying valve disease, while preserving pulmonary hemodynamics and ventricular function. TAKE-HOME MESSAGES: Progressive GLA may remain compatible with prolonged survival after successful valve surgery when ventricular function and pulmonary hemodynamics are preserved. Long-term multimodality imaging and invasive hemodynamic assessment are essential for patient management.

Discussion

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Cite This Study

Agostini et al. (2026) conducted a case report in Giant left atrium (n=1). Clinical observation of giant left atrium was evaluated on Clinical stability and hemodynamic preservation despite progressive left atrial enlargement. Extreme giant left atrium progressively enlarged to 1,172 mL/m2 over two decades following valve surgery, remaining compatible with prolonged survival due to preserved normal hemodynamics.

synapsesocial.com/papers/6ad0fcf615427f6a84040468 https://doi.org/10.1016/j.jaccas.2026.110242

View Full Paper

Ask AI

Bookmark

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Progressive Giant Left Atrium After Valve Surgery With Preserved Hemodynamics

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Progressive Giant Left Atrium After Valve Surgery With Preserved Hemodynamics

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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