Worsened breathlessness

A middle-aged male patient complained that his breathlessness had worsened during the previous six months (New York Heart Association class IV). His chest X-ray (figure) revealed extensive cardiomegaly, sometimes known as the "wall-to-wall" heart, with a CTR of 1. His transthoracic echocardiogram revealed situs solitus dextrocardia, atrioventricular/ventriculoarterial concordance, a sizable aneurysmal left atrium (LA), significant mitral regurgitation, and significant pulmonary hypertension. The significantly dilated LA covered the whole left thoracic cavity and moved the dextroposed heart to the right side of the chest, giving the chest X-ray a CTR of 1. He was identified as having congestive heart failure, dextrocardia, a congenital left atrial aneurysm, and atrial fibrillation.