Erlenmeyer-shaped Heart in a Patient with Giant Left Atrium due to Mixed Mitral Valve Pathology: A Neglected Case in a Rural Area in Indonesia

Giant left atrium (GLA) is a rare condition typically found in patients with rheumatic mitral valve disease. On chest radiographs, this often mimics another cause of cardiomegaly. A 52-year-old man was admitted to the hospital complaints shortness breath and orthopnea. Mid-diastolic grade IV pansystolic murmurs could be heard at apex radiating axilla on cardiac auscultation. The electrocardiogram showed junctional tachycardia rhythm, while radiograph displayed extreme cardiomegaly Erlenmeyer-shaped heart. Massive pericardial effusion suspected. Transthoracic echocardiography (TTE) then performed, revealing GLA atrial volume index (LAVi) 1101 ml/m2. Meanwhile, transoesophageal (TEE) confirmed calcification P2 P3 extending border leaflet up one third chordae tendineae, moderate stenosis eccentric regurgitation jet due prolapse A2. patient treated optimal medical therapy awaiting surgery. complication disease an almost forgotten Diagnostic imaging procedures are less invasive readily available modality establish diagnosis