An extreme giant left atrium exceeding 160 mm in rheumatic mitral valve disease: a case report

Abstract Background Giant left atrium is a rare complication of chronic rheumatic mitral valve disease. We report an extreme case to highlight the technical challenges and clinical considerations in the surgical management of this uncommon condition. Case presentation A 46-year-old woman with rheumatic mitral valve disease, permanent atrial fibrillation, and right heart failure presented with dysphagia and hoarseness. Computed tomography showed a left atrial anteroposterior diameter of 167 mm and a computed volume of 2,225 to 2,411 mL, among the largest ever documented. She underwent mitral valve replacement, tricuspid annuloplasty, and left atrial plication. Surgery was technically successful, with visible intraoperative reduction in atrial size and a subsequent decrease in cardiac silhouette on early postoperative chest radiography, but the patient died on postoperative day 12 from refractory low cardiac output and drug-resistant ventilator-associated pneumonia. Conclusions This case illustrates an extreme presentation of giant left atrium associated with rheumatic mitral valve disease. Although surgical reduction was technically feasible, careful patient selection and preoperative optimization remain crucial in patients with advanced right heart failure and low physiological reserve.