10 Hewett P. Aneurysmal dilation of the left auricle with thickening and contraction of the left ventricular opening.

3 El Maghraby A.

Hajar R. Giant left atrium: a review.

11 Kadoya Y.

Yamano M.

Matoba S. Sludge in a giant left atrium.

3 El Maghraby A.

Hajar R. Giant left atrium: a review.

GLA, as described by Hewett in 1849, is defined as an aneurysmal dilation of the left atrium and contraction of the left atrioventricular opening in the context of mitral valve disease.Using the echocardiographic criterion of an anteroposterior diameter ≥ 8 cm, the occurrence of GLA among patients with RHD was 0.6%.Complications include atrial fibrillation, spontaneous echocardiographic contrast, sludge, or thrombus leading to thromboembolism. In addition, there may be compression of adjacent structures, including an interatrial septal bulge leading to partial inferior vena cava obstruction, compression of main bronchus causing right middle lobe collapse, or the esophagus leading to dysphagia,for which a patient may undergo left atrial volume reduction surgery.Our patient had severe mitral stenosis due to RHD leading to GLA with the presence of sludge. Fortunately, imaging did not exhibit any compressive complications. Nevertheless, the massive enlargement of the left atrium may restrict lung capacity as it competes for intrathoracic space. Because of our patient's severe comorbidities, he was deemed at very high risk for surgical intervention. The large amount of sludge and mitral regurgitation precluded percutaneous mitral valve balloon valvuloplasty. He will be managed with continued rate control of his atrial fibrillation in addition to anticoagulation with a vitamin K antagonist. This case presentation illustrates the tremendous remodeling capability of the left atrium and the complexity of managing RHD with GLA.