Porcelain Atrium: A Case Report with Literature Review

Leacock, Krystle; Duerinckx, André J.; Davis, Bonnie

doi:10.1155/2011/501396

Cited by 12 publications

(11 citation statements)

References 9 publications

(15 reference statements)

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“…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]. The interatrial septum is usually spared, and this allows surgical approaches to the mitral valve.…”

Section: Discussionmentioning

confidence: 99%

“…Although 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.…”

Section: Introductionmentioning

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: 99%

Section: Introductionmentioning

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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“…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 case report and review of the literature

Hosseini

Rezaei

Samiei

et al. 2017

Gen Thorac Cardiovasc Surg

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Left atrial (LA) calcification is mostly observed in patients with rheumatic mitral valve (MV) diseases who underwent surgical treatment. We report a case of LA calcification in a 69-year-old woman presented with dyspnea and cyanosis. Admission electrocardiogram showed atrial fibrillation and biventricular hypertrophy. Her chest roentgenogram revealed cardiomegaly and a curvilinear whitish shadow in the area of LA. Transthoracic echocardiography revealed severe mitral stenosis and massive LA thrombosis. The patient underwent an emergent surgery, during which the whitish line on chest roentgenogram proved to be a calcified LA inner wall. During an on-pump surgery with cardioplegic arrest, she underwent open MV commissurotomy along with the excision of calcified LA wall and clots. The patient was discharged with no complications. Literature reviews showed that this entity is mainly observed in patients with rheumatic heart disease and presented with respiratory symptoms. The diagnostic modalities, management, and prognosis of previous cases were summarized.

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Porcelain Atrium: A Case Report with Literature Review

Cited by 12 publications

References 9 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

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

Massive left atrial calcification: a case report and review of the literature

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