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- Tomitaka Wakaki, Wakana Sato, Mayu Suzuki, and Hiroyuki Watanabe.
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan.
- Intern. Med. 2024 Aug 15; 63 (16): 228922922289-2292.
AbstractWe herein report a 61-year-old woman with a history of mitral valve replacement for rheumatic fever who presented with crural edema and ascites. Computed tomography showed massive left atrial (LA) calcification involving the interatrial septum, termed "coconut atrium." Catheterization revealed not only pulmonary artery hypertension but also a large V-wave in the pulmonary artery wedge pressure waveform and a dip-and-plateau pattern of right ventricular pressure. Three-dimensional transthoracic echocardiography confirmed the early attainment of peak LA volume and a decreased LA expansion index. Stiff LA syndrome due to coconut LA results in the development of restrictive right ventricular physiology.
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