[HSF] LA Size, correlation with valve disease

[Nasser F. Abou'Seada]

Dear Bob 
Thank you for your critical observation. we Have seen giant Large atrial
enlargement in cases of Severe isolated MS .... and also combined organic
rheumatic Mitral Disease. You are certainly right, in cases of functional
mitral regurgitation, e.g. Rheumatic Aortic regurgitation, known for long,
with developing new mitral regurgitation, the atrial size is seldom beyond
normal dimensions -an anecdotal observation- still, in cases of combined
double valve affection i.e. Mitral Reg / Mitral Stenosis, Aortic Reg +/-
Aortic stenosis .... the atrial size is often enlarged beyond normal limits
..... be it associated with AS or just AR ...... 

We have observed that the size of the left atrium correlates well with the
nature of the rheumatic affection of the valves ... oftenly with primarily
affected mitral valve first. In cases of primary Mitral valve affection with
later aortic valve affection -AR- the left atrium is almost always large
from the start .... whereas in cases of mainly aortic regurgitation with
later development of mitral regurgitation .. -as well from later rheumatic
affection, as seen intraoperatively- ... the left atrial size is almost
always of below normal limits of dimensions. 

It is in particular how the figure of the patient does correlate well
-anecdotal- with his sequence of valve affection, whereas essentially aortic
regurgitation patients are tall of large big built & size, essentially
males, still suffering from double valve diseases, Rheumatic mitral valve
patients are mostly females, certainly shorter than average, albeit they
suffer from double valve affection as well ...... 
Stenotic valve patients are particularly identifiable from a distance ..... 

> The truly giant ones (much more than 6 cm) that I saw in the  past were,
> always rheumatics with dominant stenosis (when they had mitral  and
tricuspid
> disease we called them "wall to wall hearts"). 
> My suspicion was that the very high mean pressures  of dominant mitral
> stenosis combined with rheumatic carditis of the atrial wall accounted for
the
> extreme forms of atrial enlargement.
> Atrial enlargement obviously also occurs with organic mitral Mitr  Reg..
> Severe organic MR can go on for 5 years or more before  producing
secondary
> ventricular dysfunction. 
> On the other hand mitral  insufficiency secondary to
> ventricular dysfunction is of a lesser degree for a  much shorter time
before
> surgery becomes urgent. Giant left atria have  less time and less stimulus
to
> form. I certainly never saw really giant  left atria in ventricular
mechanism MR.
> Maybe Hal  or other HSF members  have seen some in their collective large
> experience.
> Yours
> Bob