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Wakaki T, Sato W, Suzuki M, Watanabe H. Coconut Atrium Causing Restrictive Physiology in the Right Ventricle. Intern Med 2024; 63:2289-2292. [PMID: 38104988 PMCID: PMC11414358 DOI: 10.2169/internalmedicine.2946-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
We herein report a 61-year-old woman with a history of mitral valve replacement for rheumatic fever who presented with crural edema and ascites. Computed tomography showed massive left atrial (LA) calcification involving the interatrial septum, termed "coconut atrium." Catheterization revealed not only pulmonary artery hypertension but also a large V-wave in the pulmonary artery wedge pressure waveform and a dip-and-plateau pattern of right ventricular pressure. Three-dimensional transthoracic echocardiography confirmed the early attainment of peak LA volume and a decreased LA expansion index. Stiff LA syndrome due to coconut LA results in the development of restrictive right ventricular physiology.
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Affiliation(s)
- Tomitaka Wakaki
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
| | - Wakana Sato
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
| | - Mayu Suzuki
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
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2
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Chamberlin JH, Smith CD, Gowani Z, Elsayed MG, Owji SC, Friedman B, Maisuria D, Berrios C, Baruah D, Schoepf UJ, Kabakus IM. Left atrial calcification on chest CT: atrial ablation replaces rheumatic heart disease as the most identified etiology. Pol J Radiol 2023; 88:e423-e429. [PMID: 37808170 PMCID: PMC10551739 DOI: 10.5114/pjr.2023.131214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose Left atrial calcification (LAC), a primarily radiologic diagnosis, has been associated with rheumatic heart disease (RHD) and rheumatic fever (RF). However, left atrial calcification continues to be observed despite a significant decrease in the prevalence of rheumatic heart disease. The purpose of this study was to investigate other possible etiologies of left atrial calcification. Material and methods This retrospective, observational single-center study included patients from 2017 to 2022 identified as having left atrial calcification as well as age- and sex-matched controls. The prevalence of rheumatic heart disease, atrial ablation, and mitral valve disease was compared, and odds ratios were calculated for each independent variable. Results Sixty-two patients with left atrial calcifications were included and compared with 62 controls. 87.1% of patients in the left atrial calcifications cohort had a history of atrial fibrillation compared with 21% in the control cohort (p < 0.001). 16.1% of patients in the calcifications cohort presented a history of rheumatic fever compared with zero in the control cohort (p = 0.004). 66.1% of the left atrial calcifications cohort had a history of atrial ablation compared with 6.5% of the control group (p < 0.001). The odds ratio for left atrial calcification was 19.0 vs. 4.8 for rheumatic fever (comparative odds = 4.0 for atrial ablation vs. rheumatic fever). Multivariable log model found atrial ablation to explain 79.8% of left atrial calcifications identified. Conclusions Our study found a 4-fold higher association between history of atrial ablation and left atrial calcification compared with rheumatic heart disease, suggesting a potential shift in etiology.
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Affiliation(s)
- Jordan H. Chamberlin
- Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Carter D. Smith
- Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Zain Gowani
- Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Mina Gad Elsayed
- Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Shahin C. Owji
- Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brandon Friedman
- Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Dhruw Maisuria
- Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Carly Berrios
- Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Dhiraj Baruah
- Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Uwe Joseph Schoepf
- Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ismail M. Kabakus
- Division of Cardiothoracic Imaging, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC, USA
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Massive Left Atrial Calcification in Late Rheumatic Heart Disease. CASE 2022; 6:209-211. [PMID: 35832828 PMCID: PMC9271424 DOI: 10.1016/j.case.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Massive LA calcification is a rare manifestation of long-standing RHD. This condition is not necessarily related to the severity of rheumatic valve disease. LA calcification may onset several years after surgical MVR. Although likely explained by chronic inflammation, further mechanisms remain unknown.
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Choi JY, Suh YJ, Seo J, Choi KU, Hong GR, Lee S, Lee SH, Ha JW, Kim YJ, Shim CY. Structural and Functional Characteristics of Mitral Paravalvular Leakage Identified by Multimodal Imaging and Their Implication on Clinical Presentation. J Clin Med 2021; 10:jcm10020222. [PMID: 33435160 PMCID: PMC7826927 DOI: 10.3390/jcm10020222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/27/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Clinical presentation of patients with mitral paravalvular leakage (PVL) varies from asymptomatic to heart failure related with hemolytic anemia or pulmonary hypertension. We aimed to investigate the structural and functional characteristics of mitral PVL by multimodal imaging and their association with the severity of hemolysis and hemodynamic significance. METHODS A total of 74 patients with mitral PVL who underwent both cardiac computed tomography (CT) and echocardiography from March 2010 to December 2017 was investigated. Location and size of PVL, degree of left atrial (LA) calcification as measured by CT, and hemodynamic variables as measured by echocardiography were comprehensively analyzed. To investigate the degree of hemolysis and pulmonary hypertension, level of lactate dehydrogenase (LDH) and Doppler estimated systolic pulmonary artery pressure (SPAP) were used respectively. RESULTS Level of LDH was not related to PVL perimeter and was variable, especially in patients with a small PVL. However, it was positively correlated with mean mitral regurgitation velocity. Additionally, SPAP was significantly correlated with PVL perimeter and LA calcium score. In multivariable analysis, mean mitral regurgitation velocity was significantly correlated with levels of LDH (β = 0.345; p = 0.016), and PVL perimeter and LA calcium score were independently associated with SPAP (β = 0.249; p = 0.036 and β = 0.467; p < 0.001, respectively). CONCLUSIONS Characteristics of mitral PVL and adjacent structures are associated with the severity of hemolysis and pulmonary hypertension. Evaluating the structural and functional characteristics of mitral PVL by complementary multimodal imaging would be important for understanding the clinical presentation and deciding optimal treatments for individual patients.
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Affiliation(s)
- Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea;
| | - Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jiwon Seo
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.S.); (G.-R.H.); (J.-W.H.)
| | - Kang-Un Choi
- Division of Cardiology, Department of Internal Medicine, Donguk University Gyeongju Hospital, Gyeongju 38067, Korea;
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.S.); (G.-R.H.); (J.-W.H.)
| | - Sak Lee
- Department of Cardiothoracic Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (S.L.); (S.-H.L.)
| | - Seung-Hyun Lee
- Department of Cardiothoracic Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (S.L.); (S.-H.L.)
| | - Jong-Won Ha
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.S.); (G.-R.H.); (J.-W.H.)
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence: (Y.J.K.); (C.Y.S.); Tel.: +82-2-2228-7400 (Y.J.K.); +82-2-2228-8453 (C.Y.S.); Fax: +82-2-393-3035 (Y.J.K.); +82-2-2227-7742 (C.Y.S.)
| | - Chi Young Shim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.S.); (G.-R.H.); (J.-W.H.)
- Correspondence: (Y.J.K.); (C.Y.S.); Tel.: +82-2-2228-7400 (Y.J.K.); +82-2-2228-8453 (C.Y.S.); Fax: +82-2-393-3035 (Y.J.K.); +82-2-2227-7742 (C.Y.S.)
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Choi JY, Suh YJ, Kim YJ, Lee SH, Lee S, Hong GR, Ha JW, Shim CY. Characteristics and Implications of Left Atrial Calcium on Cardiac Computed Tomography in Patients With Earlier Mitral Valve Operation. Am J Cardiol 2020; 128:60-66. [PMID: 32650925 DOI: 10.1016/j.amjcard.2020.04.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 11/18/2022]
Abstract
Left atrial calcium (LAC) is often observed in patients who have undergone mitral valve (MV) surgery, but little is known about its characteristics and clinical implications. Therefore, we sought to investigate the structural and hemodynamic significance of LAC and its association with clinical outcomes. We investigated 327 patients with repaired or prosthetic MV who underwent cardiac CT from 2010 to 2017. The degree of LAC was analyzed and classified into three groups: group 1 (no LAC), group 2 (mild-to-moderate LAC), and group 3 (severe LAC). Clinical and echocardiographic characteristics and clinical outcomes were compared in three groups. LAC was seen in 79 (24.2%) patients. Groups 2 and 3 showed more prevalent atrial fibrillation, a rheumatic etiology, a higher number of previous surgeries, a larger LA volume index, and higher pulmonary artery systolic pressure than group 1. Paravalvular leakage of the MV increased progressively according to severity of LAC (15.4% in group 1, 39.3% in group 2, and 66.7% in group 3, p <0.001). Event-free survival rate for major adverse cardiovascular adverse events (log rank p = 0.033) and all-cause mortality (log rank p <0.001) were significantly different according to LAC group. In Cox regression analyses, presence of severe LAC was an independent predictor of all-cause mortality (hazard ratio: 4.44, 95% confidence interval: 1.71 to 11.58, p = 0.002). LAC on cardiac CT is not uncommon and reflects more advanced LA remodeling and a stiff LA. The presence and severity of LAC are associated with a worse clinical outcome after MV surgery.
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Affiliation(s)
- Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Seung-Hyun Lee
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Sak Lee
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
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Ding WY, Meah M, Rao A, Borbas Z. Cardiac resynchronisation therapy in a patient with porcelain atrium. BMJ Case Rep 2020; 13:13/1/e233115. [PMID: 31900298 DOI: 10.1136/bcr-2019-233115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Wern Yew Ding
- University of Liverpool, Liverpool, UK .,Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Mohammed Meah
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Archana Rao
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Zoltan Borbas
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
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Kawakami R, Hao H, Kimura N, Komatsu S, Kodama K, Hirota S. Pathological evaluation of massive left atrial calcification 35 years after mitral-aortic valve replacement. J Cardiol Cases 2014; 11:44-47. [PMID: 30534256 DOI: 10.1016/j.jccase.2014.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/24/2014] [Accepted: 10/06/2014] [Indexed: 11/29/2022] Open
Abstract
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-year-old 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 massive atrial calcification. <Learning objective: Rheumatic calcification of entire left atrium after valve replacement surgery is known. Erosive calcification of the atrial wall with mural thrombi was identified by histology in this case. Old renal infarction was revealed by autopsy; therefore calcified atrium could be a source of distal embolism. Transmural calcification penetrated into the left atrial wall. We speculate on the difficulty in finding a cleavage plane for the endoatriectomy of massive calcified atrium in such a situation.>.
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Affiliation(s)
- Rika Kawakami
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroyuki Hao
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Naomi Kimura
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Sei Komatsu
- Cardiovascular Center, Amagasaki Central Hospital, Amagasaki, Hyogo, Japan
| | - Kazuhisa Kodama
- Cardiovascular Center, Amagasaki Central Hospital, Amagasaki, Hyogo, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Dattilo G, Anfuso C, Casale M, Giugno V, Camarda L, Laganà N, Di Bella G. Calcific left atrium: A rare consequence of endocarditis. World J Cardiol 2014; 6:1038-1040. [PMID: 25276304 PMCID: PMC4176795 DOI: 10.4330/wjc.v6.i9.1038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/15/2014] [Accepted: 07/18/2014] [Indexed: 02/06/2023] Open
Abstract
Usually, cardiac calcifications are observed in aortic and mitral valves, atrio-ventricular plane, mitral annulus, coronary arteries, pericaridium (usually causing constrictive pericarditis) and cardiac masses. Calcifications of atrial walls are unusual findings that can be identified only using imaging with high spatial resolution, such as cardiac magnetic resonance and computed tomography. We report a case of a 43-year-old patient with no history of heart disease that underwent cardiac evaluation for mild dyspnoea. The echocardiogram showed a calcific aortic valve and a hyper-echogenic lesion located in atrio-ventricular plane. The patient was submitted to cardiac magnetic resonance and to computed tomography imaging to better characterize the localization of mass. The clinical features and location of calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrio-ventricular plane and left atrium. Although we haven’t data to support a definite and clear diagnosis, the clinical features and location of the calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrio-ventricular plane and left atrium. The patient was followed for 12 mo both clinically and by electrocardiogram and echocardiography without worsening of clinical, electrocardiographic and echocardiographic data. Cardiac magnetic resonance imaging and computed tomography are ideal methods for identifying and following over time patients with calcific degeneration in the heart.
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Song Y, Shim JK, Sun JM, Lee B, Kwak YL. Echocardiographic detection of left atrial mobile calcium debris of trido valve surgery: a case report. Korean J Anesthesiol 2014; 66:314-6. [PMID: 24851169 PMCID: PMC4028561 DOI: 10.4097/kjae.2014.66.4.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/08/2013] [Accepted: 04/03/2013] [Indexed: 11/12/2022] Open
Abstract
Calcification of the cardiac chambers is among the challenges associated with reoperative cardiac surgeries by increasing the risk of systemic embolization. We experienced a case of an unexpected detected mass by intraoperative transesophageal echocardiography during weaning from cardiopulmonary bypass in a patient undergoing trido mitral and tricuspid valve replacement surgery. The surgically removed mass was identified as calcified tissue. This case shows the importance of careful echocardiographic evaluation of the left heart in patients undergoing repeat valve surgery given their greater potential for embolic sources.
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Affiliation(s)
- Young Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Min Sun
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Bora Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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Jones C, Lodhi AM, Cao LB, Chagarlamudi AK, Movahed A. Atrium of stone: A case of confined left atrial calcification without hemodynamic compromise. World J Clin Cases 2014; 2:142-145. [PMID: 24868514 PMCID: PMC4023308 DOI: 10.12998/wjcc.v2.i5.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 03/04/2014] [Accepted: 04/25/2014] [Indexed: 02/05/2023] Open
Abstract
Dystrophic cardiac calcification is often associated with conditions causing systemic inflammation and when present, is usually extensive, often encompassing multiple cardiac chambers and valves. We present an unusual case of dystrophic left atrial calcification in the setting of end stage renal disease on hemodialysis diagnosed by echocardiography and computed tomography. Significant calcium deposition is confined within the walls of the left atrium with no involvement of the mitral valve, and no hemodynamic effects.
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Vidal A, Lluberas N, Florio L, Gómez A, Russo D, Agorrody V, Albistur S, Lluberas R. Massive left atrial calcification, tracheobronchopathia osteoplastica and mitral paravalvular leak associated with cardiac rheumatic disease and previous mitral valve replacement. Int J Cardiol 2013; 167:e111-2. [PMID: 23659878 DOI: 10.1016/j.ijcard.2013.04.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 04/04/2013] [Indexed: 12/12/2022]
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