Meier Claudia, Olteanu Gabriel, Ellermeier Marc, Eisenblätter Michel, Gielen Stephan
Universitätsklinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum Ostwestfalen-Lippe, Campus Klinikum Lippe, 32756 Detmold, Germany.
Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, 48149 Münster, Germany.
J Cardiovasc Dev Dis. 2024 Sep 24;11(10):297. doi: 10.3390/jcdd11100297.
Advances in cardiovascular imaging have expanded the scope and precision of rare diagnoses. Handling a patient with a giant left atrium, we focused on the existence and associated factors of "lone giant (left or right) atria" in our clinical setting. The aim of the current study was to establish reasonable cut-off values for the diagnosis of "giant atrium". Our analysis utilised echocardiography and cardiovascular magnetic resonance (CMR) imaging databases, with the original data re-assessed to ensure consistency and comparability. Four patients met the search criteria, with two cases requiring CMR to confirm the diagnosis of "giant atrium", correcting the initial echocardiographic assessment. Both echocardiography and CMR excel in the assessment of atrial anatomy, although the superior image quality and multiplanar capabilities of CMR support its preference. In assessing the atrial size, the use of 3D volumetric measurements should replace traditional biplane methods due to the complex anatomy of the atrium. We propose the use of an indexed volume threshold (>120 mL/m) rather than simple diameter measurements for the diagnosis of "giant atria". Structural atrial abnormalities appear to correlate with an increased risk of atrial arrhythmias, while potential serious complications such as thromboembolism or compression symptoms require further observation in larger patient cohorts to establish definitive risks.
心血管成像技术的进步扩大了罕见病诊断的范围和精度。在处理一名巨大左心房患者时，我们关注在临床环境中“孤立性巨大（左或右）心房”的存在及相关因素。本研究的目的是确定诊断“巨大心房”的合理临界值。我们的分析利用了超声心动图和心血管磁共振（CMR）成像数据库，并对原始数据进行重新评估以确保一致性和可比性。4例患者符合搜索标准，其中2例需要CMR来确诊“巨大心房”，纠正了最初的超声心动图评估结果。超声心动图和CMR在评估心房解剖结构方面都很出色，不过CMR优越的图像质量和多平面成像能力使其更具优势。在评估心房大小时，由于心房解剖结构复杂，应使用三维容积测量取代传统的双平面测量方法。我们建议使用指数化容积阈值（>120 mL/m）而非简单的直径测量来诊断“巨大心房”。心房结构异常似乎与房性心律失常风险增加相关，而诸如血栓栓塞或压迫症状等潜在严重并发症需要在更大规模的患者队列中进一步观察以确定明确风险。
