A coconut left atrium 23 years after mitral valve replacement for chronic mitral stenosis

Abstract

We present the case of a 65 year-old female who was admitted to the hospital because of deterioration of chronic dyspnea. Twenty-three years prior to this admission, mitral valve replacement for chronic mitral stenosis was performed using a Starr-Edwards caged-ball prosthesis. There was severe pulmonary hypertension. On transthoracic echocardiography and on cineradiography, the function of the mitral valve prosthesis was unimpaired. However, cineradiography showed extensive mural calcification of the left atrium; we report this remarkable finding.

Massive Left Atrial Calcification Associated with Mitral Valve Replacement

“…Completed calcification of LA has been described as a 'coconut atrium'2)3) or 'porcelain atrium' 4)5). Porcelain atrium involves the LA appendage, the free wall of the LA and the mitral valve apparatus, except interatrial septum, whereas coconut atrium involves all areas of the LA 2-5). Porcelain atrium or coconut atrium is rare disease entity, furthermore the massive calcification of LA after mitral valve replacement has been reported very few the cases 6)7)…”

Massive Left Atrial Calcification in Late Rheumatic Heart Disease

“…Importantly, when this structure is affected, as in the presented case, it represents a major obstacle for surgical and interventional procedures. 4 …”

A rare case of stiff left atrial syndrome caused by both coconut left atrium and vertebral compression: a case report

“…Calcified LA is usually anecdotally reported as ‘coconut LA’ 5 or ‘porcelain LA’ 3 and has been diagnosed mostly in long-standing rheumatic mitral stenosis 1 , 2 or patients with previous mitral valve replacement 3 , 4 . Thus, prolonged inflammation and excessive extension of the LA wall may lead to LA calcification 2 .…”

“…Calcification of the left atrium (LA) is a rare condition and can be the result of long-standing rheumatic mitral stenosis 1 , 2 or an unusual complication after mitral valve replacement 3 , 4 . Cases with massive LA calcification are referred to as those with ‘coconut LA’ 5 or ‘porcelain LA’ 3 .…”