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

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 …