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I have had them, though they didn't survive long.
They need a well-established tank so that they can pull their food out of the water column. How big they get depends on the type of clam. I've seen freshwater clams that got to be half a foot or more wide, and I've seen ones that only grow to be a couple of inches.
The last question is the million dollar one. The short answer is "I don't know." The long answer is:
There is a pair of concerns regarding freshwater clams in the aquarium. The first is that, if they're caught in the wild, they have absorbed all of the different types of toxins and illnesses that exist in that body of water. This is then getting introduced to your tank.
The second is that they reproduce by making larvae, which attach to a fish's gills in order to survive. It is possible that, in a system as small as an aquarium, these larvae could attach in large enough numbers to harm the fish.
There are also concerns about water quality if they die in the tank and you don't notice, but I didn't have much problem with that. When mine died, the nitrifying colony did a good job of handling the excess ammonia, and I did a big water change to deal with the nitrate.
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