Right-Sided Heart Failure Due to Compression of the Right Atrium by Remarkable Ascending Aortic Elongation
A 71-year-old woman was admitted to our hospital because of repeated leg and face edema. The chest radiograph showed cardiomegaly and right-sided pleural effusion. Echocardiographic examination detected compression of the right atrium (RA) by dilated and elongated ascending aorta. Pulsed-wave Doppler examination demonstrated that peak diastolic velocity and mean pressure gradient through the stenotic site were 1.65 m/s and 4.8 mm Hg, respectively. MRI was performed to investigate the cardiac anatomy in detail. The left ventricle was turned sideways on the diaphragm. The ascending aorta was remarkably elongated and dilated. Thus, the initial portion of this patient’s ascending aorta ran transversely. The RA was compressed between the transverse portion of the ascending aorta and the right diaphragm (Figure 1). Right heart catheterization revealed that the maximal pressure gradient between the RA and right ventricle (RV) at deep exhalation was 8 mm Hg: mean RA pressure was 8 mm Hg, and RV pressure was 16/2 mm Hg (Figure 2A). However, the pressure gradient between the RA and RV disappeared at deep inhalation, with mean RA pressure of 8 mm Hg and RV pressure of 23/8 mm Hg (Figure 2B).
According to these findings, we diagnosed that the patient’s right-sided heart failure was due to compression of the right atrium caused by remarkable ascending aortic elongation. The patient showed marked improvement with diuretic therapy.