Porcelain Heart: Rapid Progression of Cardiac Calcification in a Patient with Hemodialysis

Abstract

Cardiac calcification usually occurs in patients with end-stage renal disease. However, rapid progression of cardiac calcification is rarely associated with secondary hyperparathyroidism of end-stage renal disease. We report a patient with end-stage renal disease who showed moderate left ventricular hypertrophy at the first echocardiography, and showed severe myocardial calcification and severe mitral valve stenosis 4 years later. We suspected a rapid progression 'porcelain heart' cardiomyopathy secondary to hyperparathyroidism of end-stage renal disease. The patient underwent parathyroidectomy, and considered mitral valve replacement.

Reversible Myocardial Calcification Following Acute Heart Failure and Kidney Injury Caused by Valsalva Sinus Rupture

“…Hemodialysis also has been shown to cause calcium and phosphorus imbalance, which may contribute to the development of myocardial calcification. However, the imbalances caused by endstage renal disease and hemodialysis are typically thought to lead to more insidious development of calcification, rather than onset within a matter of weeks, as was the case with our patient [Jing 1998;Lee 2012]. Kapandji et al [Kapandji 2018] reported that three critically ill patients underwent extracorporeal membrane oxygenation (ECMO) and had extensive myocardial calcification, which was confirmed by multimodal imaging.…”

Chronic Constrictive Pericarditis After CABG or Hemodialysis?

“…Also, in dialysis patients with secondary hyperparathyroidism, hyperphosphatemia and elevated serum calcium-phosphate products can lead to dystrophic calcification of the heart. 12 This case highlights 2 important points: the patient developed pericardial calcification even in the setting of normal calcium phosphate product resulting in a process called dystrophic calcification, and multiple factors are interlinked/intertwined (cardiac surgery, dialysis, extraskeletal calcification, recent viral infection) which could have precipitated constrictive pericarditis, and it may not always be possible to identify the exact etiology. Whatever the etiology is, the definitive treatment for constrictive pericarditis is pericardiectomy along with intensification of dialysis.…”

“…Also, in dialysis patients with secondary hyperparathyroidism, hyperphosphatemia and elevated serum calcium-phosphate products can lead to dystrophic calcification of the heart. 12…”

Constrictive Pericarditis: Rapid Progression of Pericardial Calcification in a Patient With Hemodialysis and Coronary Artery Bypass Surgery

“…Secondary hyperparathyroidism, hyperphosphatemia, and elevated serum calcium-phosphate product levels lead to extraskeletal calcification and born disease, although their roles remain unexplained [7,8]. In reported cases of extraskeletal calcification due to secondary hyperparathyroidism in ESRD with renal replacement therapy, the level of serum PTH values was markedly elevated greater than 1,000 pg/dL, whereas serum phosphate values, calcium-phosphate product were variable: in normal range to elevated range [2,3,9,10]. In the present case, however either serum phosphate and calcium-phosphate product was well controlled and serum parathyroid hormone was not markedly elevated; we considered that calcification of pericardium was strongly associated with hemodialysis because it started after initiation of hemodialysis.…”

“…Whereas metastatic calcification occurs in normal tissue with abnormal calcium-phosphate metabolism, dystrophic calcification occurs in abnormal tissue with normal calcium-phosphate metabolism [10,11]. We considered secondary hyperparathyroidism promoted dystrophic calcification of pericardium which was injured by past CABG.…”