Porcelain Left Atrium in a Patient Being Evaluated for Percutaneous Closure of a Patent Foramen Ovale

Left atrial wall calcification is a rare finding, typically associated with rheumatic heart disease, prior atrial surgery, or chronic inflammatory states. Its presence can complicate transcatheter procedures by creating a rigid and irregular substrate for device deployment. We report the case of a 54-year-old woman with no history of rheumatic disease, prior cardiac surgery, or other conditions predisposing to atrial calcification, in whom an unusual crescent-shaped, non-annular left atrial calcification was unexpectedly identified during percutaneous closure of a patent foramen ovale (PFO). Successful device implantation was achieved using an UltraSept™ occluder, underscoring the relevance of multimodality imaging and individualized device selection in challenging anatomies.