International Journal of Cardiology 193 (2015) 47–48
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Giant right atrium due to rheumatic tricuspid valve stenosis Uğur Aksu ⁎, Selim Topcu Atatürk University, Faculty of Medicine, Department of Cardiology, Erzurum, Turkey
a r t i c l e
i n f o
Article history: Received 6 May 2015 Accepted 7 May 2015 Available online 9 May 2015 Keywords: Giant right atrium Tricuspid stenosis
A 65 year old female with a known history of rheumatic heart disease was referred to our cardiology department because of progressive dyspnea, lower extremity edema and palpitation. Physical examination revealed mild respiratory distress with 25 breaths/min. Her pulse rate was 110 beats per minute, blood pressure 90/45 mm Hg and oxygen saturation 85% while she was breathing ambient air. Her neck veins were distended with raised jugular venous pressure. Cardiac auscultation revealed a diastolic heart murmur over the right sternal borders. An electrocardiogram showed atrial fibrillation with rapid ventricular response. Hematological and biochemical parameters were normal. Chest X-ray showed cardiomegaly that mimics paracardiac mass (Fig. 1). Echocardiography revealed enlarged right atrium which had linear dimensions of 95 ∗ 90 mm with severe tricuspid stenosis (the gradient was found to be 25 and there was severe tricuspid stenosis with a mean gradient of 17 mm Hg). There was no biochemical or CT evidence of carcinoid heart disease, Ebstein's anomaly and severe left sided valvular heart disease. Rheumatic tricuspid stenosis was diagnosed and surgery was planned. However, patient refused the surgery. She was discharged from hospital 6 days after admission (Figs. 2 and 3, Movie 1). Right atrial dilatation due to tricuspid stenosis is very rare and clinical presentation varies widely, approximately half of patients are asymptomatic at the time of diagnosis [1,2]. Reported symptoms commonly include atrial fibrillation and right heart failure. This situation must be distinguished from more common structural lesions, such as Ebstein's anomaly, mitral, aortic valve disease and left sided heart failure. The treatment of tricuspid stenosis is still controversial [1,3–6].
⁎ Corresponding author at: Atatürk University, Faculty of Medicine, Department of Cardiology, Yakutiye Training and Research Hospital, Erzurum, Turkey. E-mail address: [email protected] (U. Aksu).
http://dx.doi.org/10.1016/j.ijcard.2015.05.049 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
Fig. 1. Chest X-ray revealed cardiomegaly that mimics paracardiac mass.
Fig. 2. Giant right atrium from apical four chamber view.
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U. Aksu, S. Topcu / International Journal of Cardiology 193 (2015) 47–48
Conflict of interests There is no conflict of interests.
References [1] P. Moceri, N. Berkane, C. Checler, O. Chiche, E. Ferrari, Giant congenital right atrium: a very rare entity diagnosed in an adult patient, Int. J. Cardiol. 166 (2) (2013) e36–e37. [2] Y. Imren, V. Halit, S. Kula, R. Olgunturk, Giant right atrial aneurysm: case report, Int. J. Cardiol. 112 (3) (2006) e66–e68. [3] M.Y. Chen, Z.Q. Ying, Giant left atrium in a patient with prosthetic mitral valve, Int. J. Cardiol. 172 (3) (2014) e487–e488. [4] P. Fonseca, J. Ribeiro, N. Bettencourt, L. Adao, V. Gama, Giant and electrically silent right atrium, Eur. Heart J. Cardiovas. Imaging (2015). [5] A. Loch, M.A. Sadiq, W.A. Wan Ahmad, Giant left atrium in a patient with prosthetic mitral valve, Eur. Heart J. 34 (13) (2013) 981. [6] A. Shamsian, J. Abraham, A. Alani, M.J. Budoff, Giant left atrium in 72 year old male, Int. J. Cardiol. 181 (2015) 347–348. Fig. 3. Severe tricuspid stenosis from apical four chamber view.
Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ijcard.2015.05.049.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Giant right atrium due to rheumatic tricuspid valve stenosis Uğur Aksu ⁎, Selim Topcu Atatürk University, Faculty of Medicine, Department of Cardiology, Erzurum, Turkey
a r t i c l e
i n f o
Article history: Received 6 May 2015 Accepted 7 May 2015 Available online 9 May 2015 Keywords: Giant right atrium Tricuspid stenosis
A 65 year old female with a known history of rheumatic heart disease was referred to our cardiology department because of progressive dyspnea, lower extremity edema and palpitation. Physical examination revealed mild respiratory distress with 25 breaths/min. Her pulse rate was 110 beats per minute, blood pressure 90/45 mm Hg and oxygen saturation 85% while she was breathing ambient air. Her neck veins were distended with raised jugular venous pressure. Cardiac auscultation revealed a diastolic heart murmur over the right sternal borders. An electrocardiogram showed atrial fibrillation with rapid ventricular response. Hematological and biochemical parameters were normal. Chest X-ray showed cardiomegaly that mimics paracardiac mass (Fig. 1). Echocardiography revealed enlarged right atrium which had linear dimensions of 95 ∗ 90 mm with severe tricuspid stenosis (the gradient was found to be 25 and there was severe tricuspid stenosis with a mean gradient of 17 mm Hg). There was no biochemical or CT evidence of carcinoid heart disease, Ebstein's anomaly and severe left sided valvular heart disease. Rheumatic tricuspid stenosis was diagnosed and surgery was planned. However, patient refused the surgery. She was discharged from hospital 6 days after admission (Figs. 2 and 3, Movie 1). Right atrial dilatation due to tricuspid stenosis is very rare and clinical presentation varies widely, approximately half of patients are asymptomatic at the time of diagnosis [1,2]. Reported symptoms commonly include atrial fibrillation and right heart failure. This situation must be distinguished from more common structural lesions, such as Ebstein's anomaly, mitral, aortic valve disease and left sided heart failure. The treatment of tricuspid stenosis is still controversial [1,3–6].
⁎ Corresponding author at: Atatürk University, Faculty of Medicine, Department of Cardiology, Yakutiye Training and Research Hospital, Erzurum, Turkey. E-mail address: [email protected] (U. Aksu).
http://dx.doi.org/10.1016/j.ijcard.2015.05.049 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
Fig. 1. Chest X-ray revealed cardiomegaly that mimics paracardiac mass.
Fig. 2. Giant right atrium from apical four chamber view.
48
U. Aksu, S. Topcu / International Journal of Cardiology 193 (2015) 47–48
Conflict of interests There is no conflict of interests.
References [1] P. Moceri, N. Berkane, C. Checler, O. Chiche, E. Ferrari, Giant congenital right atrium: a very rare entity diagnosed in an adult patient, Int. J. Cardiol. 166 (2) (2013) e36–e37. [2] Y. Imren, V. Halit, S. Kula, R. Olgunturk, Giant right atrial aneurysm: case report, Int. J. Cardiol. 112 (3) (2006) e66–e68. [3] M.Y. Chen, Z.Q. Ying, Giant left atrium in a patient with prosthetic mitral valve, Int. J. Cardiol. 172 (3) (2014) e487–e488. [4] P. Fonseca, J. Ribeiro, N. Bettencourt, L. Adao, V. Gama, Giant and electrically silent right atrium, Eur. Heart J. Cardiovas. Imaging (2015). [5] A. Loch, M.A. Sadiq, W.A. Wan Ahmad, Giant left atrium in a patient with prosthetic mitral valve, Eur. Heart J. 34 (13) (2013) 981. [6] A. Shamsian, J. Abraham, A. Alani, M.J. Budoff, Giant left atrium in 72 year old male, Int. J. Cardiol. 181 (2015) 347–348. Fig. 3. Severe tricuspid stenosis from apical four chamber view.
Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ijcard.2015.05.049.
