Massive calcification of the left atrium: Surgical implications

Vallejo, José Luis; Merino, C; González-Santos, José María; Bastida, E; Albertos, J; Riesgo, Manuel Fernández del; Diego, F.

doi:10.1016/0003-4975(95)00583-7

Cited by 37 publications

(23 citation statements)

References 7 publications

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“…It is common practice to approach the mitral valve through the right atrium and interatrial septum, which is often free from calcification [6,7]. However, this case had no spare area without calcification in the interatrial septum.…”

Section: Discussionmentioning

confidence: 91%

“…Calcification of the left atrium is an uncommon complication of long-standing rheumatic valve disease, and is frequently revealed in patients with a previous operation on the mitral valve [5][6][7]. If the heavy calcification was observed in the left atrial appendage, the atrial free wall, and the mitral valve apparatus, the term ''porcelain atrium'' is used [1,[8][9][10].…”

Section: Discussionmentioning

confidence: 99%

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Pathological evaluation of massive left atrial calcification 35 years after mitral-aortic valve replacement

Kawakami

Hao

Kimura

et al. 2015

Journal of Cardiology Cases

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IntroductionAlthough calcification of the left atrium is relatively common in the setting of long-lasting rheumatic valve disease, massive calcification of the left atrium, also known as ''porcelain atrium [1],'' ''coconut atrium [2], '' or ''mold-like calcification [3],'' is a rare condition. The left atrial calcification is described as a high-density ring encircling the left atrium on chest X-ray. Noncontrast computed tomographic (CT) scan of the thorax reveals deposition of calcification in the wall of the left atrium. This is, to the best of our knowledge, the first case report for precise histopathological evaluation of rheumatic massive left atrial calcification by autopsy specimen. Case reportAn 84-year-old woman had been treated by our cardiology department with congestive heart failure as an outpatient. Her medical history revealed rheumatic valvulopathy and surgery of mitral-aortic valve replacement to mechanical heart valves, the St. Jude bileaflet valves in 1979 in another institution. Replacements of dysfunctioning prostheses to the St. Jude valves were performed in 1992 and 2000. More recently, she had implanted VVI pacemaker due to atrial fibrillation-related bradycardia in 2008. Warfarin treatment indicated prothrombin time-international normalized ratio 1.2-1.4 during her outpatient therapy. Chronic renal failure was pointed out and her estimated glomerular filtration rate was 45-55 ml/min/1.73 m 2 . She was admitted to our hospital due to worsening of congestive heart failure. Chest roentgenogram showed severe cardiomegaly with rim of calcification outlining the enlarged left atrium (Fig. 1A). Echocardiography revealed enlarged left atrium A B S T R A C T Massive calcification of the left atrium is an uncommon complication of long-standing rheumatic valve disease, and is frequently revealed in patients with a previous operation on the mitral valve. An 84-yearold woman, who had a history of rheumatic valvulopathy and mitral-aortic valve replacement surgery 35 years previously, was admitted to our hospital due to congestive heart failure. Chest X-ray showed severe cardiomegaly with rim of calcification outlining the enlarged left atrium. Computed tomographic scan of the thorax clearly illustrated dense and partially thick plate-like calcification of left atrial free wall and interatrial septum. She died due to congestive heart failure 14 days after hospitalization and an autopsy was performed. Enlargement of left atrium with massive calcification was evident by gross pathology. Thick plate-like calcification with both erosion and mural hemorrhage was clearly shown by a cross-section of atrial wall. Organized and fresh fibrin thrombi were identified at the surface of left atrium. Calcified tissue penetrated into the wall of the left atrium and lack of myocardium underneath the massive calcified lesion was evident. Although rheumatic calcification of left atrium revealed by medical images was previously described, this is the first case report that demonstrates histopathological evaluation of massi...

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Pathological evaluation of massive left atrial calcification 35 years after mitral-aortic valve replacement

Kawakami

Hao

Kimura

et al. 2015

Journal of Cardiology Cases

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“…Besides surgical trauma, rheumatic valve disease itself can lead to calcification of the adjacent heart chambers. In patients with chronic rheumatic mitral disease, LA wall calcification is frequently observed, which is associated with rheumatic involvement of the endocardium and chronic strain forces originating from mitral pathology [5]. Rarely, a massive LA calcification, a so called "coconut atrium", been reported.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic detection of left atrial mobile calcium debris of trido valve surgery: a case report

Song

Shim

Sun

et al. 2014

Korean J Anesthesiol

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Calcification of the cardiac chambers is among the challenges associated with reoperative cardiac surgeries by increasing the risk of systemic embolization. We experienced a case of an unexpected detected mass by intraoperative transesophageal echocardiography during weaning from cardiopulmonary bypass in a patient undergoing trido mitral and tricuspid valve replacement surgery. The surgically removed mass was identified as calcified tissue. This case shows the importance of careful echocardiographic evaluation of the left heart in patients undergoing repeat valve surgery given their greater potential for embolic sources.

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“…The presence of LA calcification, also known as "porcelain atrium" or "coconut atrium," has been reported as a result of extensive rheumatic pancarditis. 2,3 The etiology of tracheobronchopathia osteoplastica, a mostly asymptomatic condition of the tracheobronchial tree with a probably benign course, is still unknown. 4 Several other mechanisms may account for endo- …”

Section: Discussionmentioning

confidence: 99%

Endocardial Calcification of Left Atrium, Tracheobronchopathia Osteoplastica, and Calcified Aortic Arch in a Patient With Dyspnea

Müller

Gielen

Schuler

et al. 2008

Circ: Heart Failure

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A 69-year-old female patient was admitted to our hospital for further cardiac evaluation with symptoms of dyspnea (New York Heart Association class III) and peripheral edema. Her history revealed artificial mitral valve replacement due to mitral stenosis 8 years earlier, severe chronic pulmonary hypertension, and severe tricuspid valve incompetence.Electrocardiogram showed normofrequent atrial fibrillation. Transthoracic echocardiography indicated moderate biatrial enlargement, although both ventricles had normal dimensions and normal global systolic function. The transmitral prosthetic valve gradient was 14/6 mm Hg. We documented severe tricuspid regurgitation and only mild mitral regurgitation. Nevertheless, echocardiography was difficult to perform because of lack of an adequate acoustic window and metal artifacts of the mitral valve prosthesis. Reflections at the epicardial surface close to the mitral valve were therefore interpreted as calcifications of pericardial layer, and constrictive pericarditis was expected to be the most likely cause of the patient's symptoms and diastolic left ventricle dysfunction.By right heart catheterization, severe postcapillary hypertension was confirmed (systolic/diastolic/mean pulmonary artery pressure, 65/23/43 mm Hg; mean pulmonary wedge pressure, 29 mm Hg). In all cardiac cavities, an end-diastolic pressure equilibration was measured (Figure 1). Pressure curves did not show a dip-plateau phenomenon. Therefore, constrictive pericarditis was excluded. However, in a 64-row multidetector computed tomography scan, the endocardial layer of the left atrium (LA) and the aortic arch were heavily calcified (Figure 2), whereas the pericardium itself did not show any relevant calcifications. As an additional finding, the patient showed tracheobronchopathia osteoplastica ( Figure 2A and 2B). Cardiac MRI was performed to further assess ventricular and atrial function (Figure 3). Any acute or persistent cardiac inflammation or interstitial storage cardiomyopathy could be excluded by edema-sensitive T2-weighted short T1 inversion recovery (STIR) images and T1-weighted images early and late after intravenous Gd-DTPA according to the protocol previously described. 1 The

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Massive calcification of the left atrium: Surgical implications

Cited by 37 publications

References 7 publications

Pathological evaluation of massive left atrial calcification 35 years after mitral-aortic valve replacement

Pathological evaluation of massive left atrial calcification 35 years after mitral-aortic valve replacement

Echocardiographic detection of left atrial mobile calcium debris of trido valve surgery: a case report

Endocardial Calcification of Left Atrium, Tracheobronchopathia Osteoplastica, and Calcified Aortic Arch in a Patient With Dyspnea

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