Aetiology and Clinical Profile of Giant Left Atrium – An Observational Study

A K M Monwarul Islam, Abdullah AS Majumder, Mohammad Ullah, Md Toufiqur Rahman, Md Khalequzzaman, Md Kabiruzzaman, Sujit Kumar Ghosh, Shovan Rahman, Bijoy Dutta, Shahriar Azad, Tanveer Ahmad, Shahriar Kabir, AbuI Hasan Muhammad Bashar, Mezbah Uddin Ahmed

Background: The predominant cause of giant left atrium (GLA) is rheumatic mitral valvular disease.
GLA is commonly defined echocardiographic ally by measuring the left atrial diameter (LAD). In the
context of changing epidemiology of rheumatic heart disease (RHD) globally, and introduction of left
atrial volume index (LAVI), the aetiology of GLA and utility of LAVI for defining GLA may be necessary.
Methods: The prospective observational study was carried out at a dedicated tertiary care cardiac centre
of a developing country to know the aetiology and clinical pattern of GLA over 8 years. GLA was defined
echocardiographic ally as a left atrium (LA) having a diameter e”80 mm in the left parasternal long-axis
view. Follow-up was made over the telephone.
Results: Thirty cases of GLA were diagnosed over 8 years from 2013 to 2021. Twenty two were due to
rheumatic heart disease (RHD), 7 due to MVP, and 1 due to flail anterior mitral leaflet. Mean LAD was
92.13 ± 16.72 mm, and the mean LAVI was 288.77 ± 134.40 ml/m2
. LA thrombus was present in 5
patients, 6 had spontaneous echo contrast (SEC) in LA, 2 had both LA thrombus and SEC. Mean followup was 0.99 ± 1.06 years. Out of 15 patients, 5 died, while 10 were alive. Mean survival was 1.8 ± 1.17
years, ranging from less than 1 year to 4 years.
Conclusion: RHD continues to be the predominant cause of GLA; however, MVP is also important. The
cut-off value of LAVI for defining GLA needs further study