# Minimally Invasive Mitral Valve Replacement in a Patient With a Giant Left Atrium

## TL;DR

A patient with an extremely enlarged left atrium successfully underwent minimally invasive mitral valve replacement, showing it's possible even in complex cases.

## Contribution

Demonstrates the feasibility of minimally invasive mitral valve replacement in a patient with an exceptionally large left atrium.

## Key findings

- A 50-year-old male with a 17.1 cm left atrial diameter underwent successful minimally invasive mitral valve replacement.
- The procedure was completed safely using advanced imaging and specialized techniques, avoiding sternotomy.
- This case highlights the potential for minimally invasive approaches in complex mitral valve disease.

## Abstract

A giant left atrium (GLA) is a challenging manifestation of advanced mitral valve disease, often necessitating mitral valve surgery via median sternotomy due to the anatomical distortion it causes. We present the case of a 50-year-old male patient with New York Heart Association (NYHA) class IV symptoms secondary to severe mitral regurgitation, found to have a left atrial diameter of 17.1 cm, to our knowledge, one of the largest ever reported. After declining sternotomy, the patient underwent successful minimally invasive mitral valve replacement. Despite significant anatomical challenges, the procedure was completed uneventfully through careful preoperative planning and specialized intraoperative techniques. While sternotomy remains standard in such complex presentations, advances in imaging, instrumentation, and surgical expertise are redefining procedural boundaries. This case demonstrates that minimally invasive mitral valve replacement can be safe, feasible, and effective even in patients with extreme atrial enlargement when performed by experienced teams.