Massive left atrial calcification: A limitation of transesophageal echocardiography

Vilacosta, Isidre; Gómez, Jorge; Almerı́a, Carlos; Castillo, Juan Antonio; Román, JoséAlberto San; Zamorano, José; Rollán, María Jesús; Vida, Inés; Harguindey, Luis Sánchez

doi:10.1016/0002-8703(94)90146-5

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…In general, transesophageal echocardiography permits admirable visualization of the LA compared with transthoracic echocardiography because of the anatomic accessibility of the esophagus. However transesophageal imaging is significantly impaired in the presence of calcified walls of LA 15). Adequacy of transesophageal and transthoracic echocardiographic imaging possibly depends on the extent and the density of calcification 16).…”

Section: Discussionmentioning

confidence: 99%

Massive Left Atrial Calcification Associated with Mitral Valve Replacement

Lee

Son

Yoon

et al. 2010

J Cardiovasc Ultrasound

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Calcification of the left atrium can be observed in patients with a long-lasting rheumatic heart disease. However, massive calcification of the atrial wall, so called porcelain or coconut atrium is very rare and has been generally reported only as incidental radiographic findings. We report a case of massive and firm calcifications at the left atrium in patient who underwent mitral valve replacement.

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Section: Discussionmentioning

confidence: 99%

Massive Left Atrial Calcification Associated with Mitral Valve Replacement

Lee

Son

Yoon

et al. 2010

J Cardiovasc Ultrasound

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“…However, there is debate as to whether calcification limits the use of this technique. Vilacosta et al [6] found it to be an inadequate study for patients with left atrial calcification, while Goel and Singh [7] found the technique to be sufficient. Goel and Singh [7] postulated that the “adequacy of transesophageal imaging possibly depends on the extent and the density of calcification,” and that, “there may have been some less dense areas through which a satisfactory window could probably be obtained.” It is also important to note that fluoroscopic evaluation of the chest is more sensitive to the presence of calcium than plain films [8], however, CT is superior to both fluoroscopy and plain films.…”

Section: Discussionmentioning

confidence: 99%

Porcelain Atrium: A Case Report with Literature Review

Leacock

Duerinckx

Davis

2011

Case Reports in Radiology

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Massive left atrial wall calcification, or porcelain atrium, is very rare. We describe a case of an unusual pattern of cardiac calcification demonstrated on routine preoperative chest X-ray for cataract surgery in a 71-year-old Nigerian woman. Past medical history was significant for mitral stenosis and atrial fibrillation. Radiographic imaging revealed curvilinear high density areas of calcification outlining the left atrium on the chest X-ray. Noncontrast CT scan of the thorax confirmed the left atrial distribution of calcification and, thus, the diagnosis of porcelain left atrium.

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“…During atherogenesis, endothelial dysfunction plays an important role in vascular calcification. Several investigators have demonstrated that the endothelium is a source of osteoprogenitor cells in vascular calcification [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Further inflammation during the healing process of rheumatic carditis may be involved in the pathogenesis of rheumatic heart disease.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Indeed, atrial fibrillation of many years duration is almost universal. The advanced electro anatomical remodeling of the left atrium exacerbates the hemodynamics of heart failure; ii) the consensus of other group of investigators is that left atrial calcification is the end-result of repeated and extensive rheumatic auricularis beginning with focal patches of calcification in areas of rheumatic endocardial ulceration and progression to chronic fibrotic changes with plaques of subendocardial calcium [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. The incidence of atrial calcification appears to be related to the severity of the original rheumatic attack and the associated valvular damage.…”

Section: Pathophysiologymentioning

confidence: 99%

“…The incidence of atrial calcification appears to be related to the severity of the original rheumatic attack and the associated valvular damage. Adherent mural thrombi are a common finding [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Accurate description of the atrial calcification is missing in most published reports; iii) recent research on the mechanisms of ectopic calcification such as arterial calcification indicates that well-regulated processes, similar to those that drive osteogenesis, mediate vascular calcification [69][70][71][72][73][74][75][76][77].…”

Section: Pathophysiologymentioning

confidence: 99%

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A Treatise on the Surgical Management of Porcelain Atrium and Coconut Atrium

Chowdhury

Sankhyan

Gudala

et al. 2019

JCSHD

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The present perspective is a synthesis of 119 published investigations in the setting of porcelain atrium and coconut atrium in the literature. We identified 60 suitable cases (porcelain atrium, n=44; coconut atrium, n=16) from 34 investigations, and reviewed the clinical presentation, diagnostic modalities utilized, surgical techniques employed and outcomes. Roentgenography, cross-sectional transthoracic and transesophageal echocardiography, computerized tomography and fluoroscopy provided the necessary diagnostic information and defined the disease entity before surgery in all patients. Magnetic resonance imaging and selective coronary angiography had been used for further clarification of the presence of intraluminal left atrial thrombus. We then grouped the lesions into two categories, namely “porcelain atrium” and “coconut atrium” that have a bearing on the appropriate surgical approach, discussing appropriate surgical or non-surgical techniques for each group. For the overall group, taking into consideration of the patients subjected to surgical intervention, the operative mortality remains high at 20.6% [porcelain atrium: hospital death 6/30 (20%), coconut atrium: hospital death 1/4 (25%). We submit that an increased appreciation of different types of left atrial wall calcification may well contribute to improved surgical management.

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Massive left atrial calcification: A limitation of transesophageal echocardiography

Cited by 9 publications

References 6 publications

Massive Left Atrial Calcification Associated with Mitral Valve Replacement

Massive Left Atrial Calcification Associated with Mitral Valve Replacement

Porcelain Atrium: A Case Report with Literature Review

A Treatise on the Surgical Management of Porcelain Atrium and Coconut Atrium

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