Abstract 4369512: Porcelain Left Atrium as seen on Coronary Angiogram

Background: Circumferential calcification of the left atrium, commonly referred to as "porcelain atrium" or "coconut atrium," was first documented in 1898 in patients with rheumatic heart disease. This condition has also been observed in individuals with end-stage renal disease and those who have undergone thoracic radiotherapy. It predominantly affects women, accounting for approximately 74% of reported cases. Methodology: Informed, written consent was obtained from the patient prior to the preparation of this case report. All clinical data and patient history were collected through a one-on-one interview with the patient and a review of the patient’s electronic health records. Clinical Case: A 50-year-old female with a history of rheumatic heart disease, previously treated with closed mitral valvuloplasty and percutaneous transvenous mitral commissurotomy, presented with severe dyspnea and heartburn. She was admitted for a coronary angiogram in preparation for a double valve replacement. The angiogram revealed normal coronary arteries but significant calcification of the left atrium. Transthoracic echocardiography confirmed severe mitral stenosis, mild mitral regurgitation, moderate aortic regurgitation, and a grossly dilated left atrium, with preserved left ventricular systolic function. Following an uneventful recovery, the patient was discharged and scheduled for the planned valve surgeries. Conclusion: This case underscores the rare occurrence of massive left atrial calcification, often termed "porcelain atrium," in patients with long-standing rheumatic heart disease. Despite its rarity, such calcification can complicate surgical interventions, highlighting the need for thorough preoperative imaging and careful surgical planning. Specialized surgical techniques such as total endoatriectomy of the left atrium or calcium core debridement with valve replacement may be considered.