Reasonable and effective volume reduction of a giant left atrium associated with mitral valve disease

Severe left atrial enlargement associated with mitral valve disease has been known to carry a poor prognosis in patients undergoing mitral valve repair or replacement. There are several reasons why left atrial size can have a significantly negative impact on prognosis. A giant left atrium (LA) can cause postoperative respiratory dysfunction by bronchial and pulmonary compression and hemodynamic disturbance subsequent to compression of the posterobasal portion of the left ventricle (LV). Moreover, the presence of a giant LA can increase thromboembolic risk despite anticoagulant therapy after operation. We report a case of a 62-year-old female who had a markedly enlarged LA associated with mitral valve stenosis and regurgitation. The patient, who had severely restrictive and obstructive respiratory dysfunction, underwent mitral valve replacement and left atrial volume reduction with postoperative improvement in hemodynamic and respiratory function. We believe that volume reduction of an enlarged LA, in addition to mitral valve surgery, is important not only because it leads to improvement in heart failure but also because it will relieve compression of the adjacent organs.