Giant left atrium with calcified walls and thrombus in a patient with an old, normally functioning ball-in-cage mitral valve prosthesis.

A 64-year-old woman was admitted for dyspnea at rest and orthopnea. She had a mitral valve Starr-Edwards prosthesis implanted in 1975 for rheumatic mitral valve disease and was in permanent atrial fibrillation ever since. Chest x-ray (postero-anterior view) showed a massively enlarged cardiac silhouette with a cardiothoracic index of 0.90 and calcified contours of the right heart border, extending almost to the right lateral wall of the chest (Figure 1). Widening of the tracheal bifurcation angle was also clearly apparent in this x-ray. The lateral projection identified the grossly dilated cavity with calcified walls as being the left atrium (LA)(Figure 2). Transthoracic echocardiography