Biatrial and interatrial septal calcification in the setting of rheumatic heart disease and mitral and tricuspid valves replacement

Abstract

BackgroundAlthough cardiac calcifications are described in the literature, calcification of atria is less frequently reported. There have been few case studies about atrial wall calcification in the literature, most of which were in middle-age females and were attributable to chronic heart diseases including rheumatic heart disease and valve replacement. In majority of the reported cases, interatrial septum has been spared. Only one case of bilateral atrial wall calcification has been reported prior to the current report, which has been in a patient with renal failure, calciphylaxis and long-term haemodialysis and calcium supplement intake.Case presentationThe patient was a 57-year-old female with history of rheumatic valvular heart disease and two prior valve replacement surgeries. She didn’t have any history of renal function impairment and haemodialysis or calcium supplements intake. Her laboratory data showed anaemia, increased cardiac biomarkers and active urinalysis. Performed echocardiography showed moderate right ventricular dilation with relatively poor contraction, normal left ventricular size and contraction, dilated right and left atria and good prosthetic valve function. On computed tomography (CT) scan, calcification of left atrial posterior and free walls, interatrial septum and right atrial free wall were noted. Evidence of hepatic congestion and cirrhosis was seen in abdominal CT scan and ultrasonography.ConclusionAtrial wall calcification is a rare finding but is important to report since it can complicate cardiac surgeries. It's also probable that this kind of dystrophic calcification could not be detected during routine echocardiography and CT scan should be performed in suspected cases.