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Published on: July 20, 2022
Massive left atrial calcification: a case report and review of the literature
Saeid Hosseini1, Yousef Rezaei2, Niloufar Samiei1
1Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Insights
Left atrial calcification, a rare condition often linked to rheumatic heart disease, can cause severe respiratory symptoms. This case highlights successful surgical management of a patient with significant left atrial calcification and thrombosis.
Area of Science:
- Cardiology
- Cardiac Surgery
- Radiology
Background:
- Left atrial (LA) calcification is a rare condition, predominantly seen in patients with rheumatic mitral valve (MV) disease requiring surgical intervention.
- Rheumatic heart disease remains a primary association with LA calcification, often presenting with significant respiratory compromise.
Observation:
- A 69-year-old woman presented with dyspnea and cyanosis, exhibiting atrial fibrillation and biventricular hypertrophy on ECG.
- Chest roentgenogram showed cardiomegaly and a characteristic curvilinear shadow in the LA region.
- Transthoracic echocardiography confirmed severe mitral stenosis and massive LA thrombosis.
Findings:
- Surgical exploration revealed the whitish shadow to be a calcified inner LA wall.
- The patient successfully underwent emergent open MV commissurotomy and excision of the calcified LA wall and thrombi.
- Post-operative recovery was uneventful, with discharge without complications.
Implications:
- This case underscores the importance of considering LA calcification in patients with severe mitral stenosis and respiratory symptoms.
- Early diagnosis and surgical intervention, including calcified wall and clot excision, can lead to favorable outcomes.
- Reviewing prior literature aids in understanding the diagnostic modalities, management strategies, and prognosis of this uncommon condition.
Abstract:
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.
