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Calcium emboli to the retinal artery in calcific aortic stenosis
Insights
Calcific aortic stenosis can present as retinal artery occlusion due to calcium emboli. This visual symptom may be an early indicator of this common heart valve disease.
Area of Science:
- Cardiology
- Ophthalmology
- Vascular Medicine
Background:
- Calcific aortic stenosis is a common valvular heart disease.
- Calcium emboli from the aortic valve can travel to systemic circulation.
- Retinal artery occlusion is a known, though less common, embolic event.
Observation:
- Four cases of central retinal artery occlusion were identified over seven months.
- These cases were linked to calcific aortic stenosis.
- Other embolic sources were ruled out through diagnostic testing.
Findings:
- Retinal artery occlusion by calcium microemboli can be the initial presentation of calcific aortic stenosis.
- Two patients with this presentation underwent successful aortic valve replacement.
- Histologic studies confirm calcium emboli in various organs in calcific aortic stenosis.
Implications:
- Ophthalmologic findings, specifically vision loss, may serve as an early diagnostic clue for calcific aortic stenosis.
- Identifying retinal artery occlusion as a potential sign can lead to earlier diagnosis and treatment of aortic stenosis.
- This highlights the importance of interdisciplinary collaboration between cardiology and ophthalmology.
Abstract:
It is generally appreciated in the cardiovascular literature that calcium emboli to a central retinal artery or its branches may be the presenting feature of otherwise uncomplicated calcific aortic stenosis. The ophthalmologic literature provides good evidence for this point. Over a 7-month period, four such cases have come to our attention. Other potential sources of emboli were excluded by standard noninvasive and invasive diagnostic techniques, and two patients underwent successful aortic valve replacement. Previous studies of calcific aortic stenosis have demonstrated postmortem histologic evidence of calcium emboli to various organs, for example, heart, kidney, or brain. Since these emboli are small, their occurrence is clinically silent. The retinal circulation is unique in that its occlusion by a calcium microembolus results in loss of vision, and this symptom may be a clue to the presence of calcific aortic stenosis.