Giant left and right atrium: spectrum of rheumatic heart disease.

To cite: Mahla H, Bhairappa S, Chikkamuniswamy R, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-201853 DESCRIPTION A 19-year-old man presented with New York Heart Association class II heart failure with a history of rheumatic fever in childhood. He was on regular penicillin prophylaxis, diuretics, vasodilators and β blockers. On examination there was grade IV/VI pansystolic murmur at the apex radiating to the axilla, grade III/VI pansystolic murmur at left sternal border fourth intercostal space (increasing on inspiration). Mean jugular venous pressure was elevated (prominent v waves) with gross pedal oedema. A 12-lead ECG revealed atrial fibrillation with a controlled ventricular rate. A transthoracic echocardiogram revealed severe mitral stenosis (videos 1 and 2), moderate mitral regurgitation (video 3), severe torrential tricuspid regurgitation (video 4) and mild aortic regurgitation (video 5). There was severe right ventricular dysfunction with adequate left ventricular function. Mitral valve