Presentation
Shortness of breath on lying down.
Patient Data

Gross cardiomegaly with increased subcarinal angle and double cardiac border, suggesting left atrium enlargement.
Bilateral CP angles are blunted? Mild bilateral pleural effusion.

Post-operative chest x-ray showing mitral valve prosthesis seen in situ.
Case Discussion
Chest x-ray findings raised the possibility of valvular heart disease. On ECHO there was severe mitral regurgitation, moderate mitral stenosis, moderate pulmonary arterial hypertension, and giant left atrium.
After completing the workup and informed written consent, the patient was taken up for mitral valve replacement and left atrial appendage plication.
Co-author: Dr. Sanjay Kumar (Mch. CTVS).