Successful Surgical Management of Giant Cardiomegaly in a Patient With Multivalvular Heart Disease: A Case Report and Literature Review.

Cardiomegaly, particularly in its extreme form, is a rare but clinically significant manifestation of chronic valvular heart disease. While a cardiothoracic ratio (CTR) greater than 0.50 indicates cardiac enlargement, a CTR exceeding 0.80 is exceptionally uncommon and typically associated with advanced disease. We report the case of a 70-year-old man with severe aortic and mitral stenosis who developed acute decompensated heart failure (HF) and exhibited profound cardiomegaly (CTR ≥ 0.80). We initiated intervention upon the patient's presentation to the emergency department and closely followed his clinical progression through surgery and subsequent recovery until discharge from the ward. The patient required mechanical circulatory support, including an intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO), followed by successful aortic and mitral valve replacement, as well as tricuspid annuloplasty. Despite postoperative hemodynamic instability requiring delayed sternal closure, the patient was ultimately weaned off support and discharged in stable condition. This case underscores the prognostic value of CTR as a non-invasive marker of cardiac remodeling and highlights the potential for recovery in even extreme anatomical presentations when timely and aggressive interventions are undertaken.