Managing the Giant: A Novel Approach in Orthotopic Heart Transplantation With Extreme Left Atrial Enlargement

This case report highlights an innovative surgical approach in orthotopic heart transplantation (OHT) for a patient with the largest recorded giant left atrium, measuring a biplanar volume of 1906 mL. The patient, a 63-year-old man with severe heart failure and a history of mitral and aortic valve replacements, presented with atrial fibrillation, moderate systolic dysfunction, and severe cardiomegaly. Despite optimized medical therapy, his condition warranted heart transplantation. The procedure involved a novel surgical technique utilizing Teflon reinforcement and a bovine pericardial patch to reconstruct the significantly enlarged left atrium. Postoperative outcomes were favorable, with no rejection episodes and resolution of pulmonary symptoms. This report underscores the challenges of atrial size mismatch in OHT and the necessity for tailored surgical strategies to address extreme anatomical variations. The successful outcome exemplifies the potential of customized approaches in complex heart transplant cases.