Acquired Left Ventricular to Right Atrial Shunt Following Bicuspid Aortic Valve Endocarditis

Abstract

Introduction: Rheumatic heart disease and its sequalae sometime manifests into unique presentation. We report an interesting case of giant aneurysmal left atrium secondary to sever calcific mitral stenosis with tricuspid stenosis. Methods: A 35 year-old male presented with off and on breathlessness for five years. X-ray chest showed huge cardiomegalywith cardio-thoracic ratio one. ECGdemonstrated atrial fibrillation, 2D echocardiography had revealed severe calcific mitral stenosis (MVA .73 cm) with giant left atrium measuring (19.3 cm 14 cm), PASP 75 mm Hg, severe tricuspid stenosis (gradient 22/14) with dense smoke in left atrium. Results: Patient underwent successful mitral valve replacement using #29 SJM bileaflet with tricuspid commisurrotomy and obliteration of left atrial appendage under cardiopulmonary bypass. Post-operative echocardiography confirmed normal functioning valvular prosthesis with reduced size LA (12 cm) and PASP pressure (35 mm) and no tricuspid stenosis and regurgitation.