Massive left atrial calcification: a case report and review of the literature

Long-Term Outcomes of the Maze Procedure Combined with Endoatriectomy for Patients with Calcified Left Atria

PURPOSE

Left atrial calcification (LAC) is found in long-lasting rheumatic valvular disease and is almost always accompanied by atrial fibrillation (AF). In the presence of LAC, endoatriectomy is required when performing the maze procedure. However, the technical feasibility of endoatriectomy and the long-term outcomes of the maze procedure in patients with LAC are uncertain.

METHODS

The medical records of 18 consecutive patients who underwent combined endoatriectomy and maze procedure were analyzed retrospectively.

RESULTS

Accompanying operations were mitral valve replacement (n = 16) and commissurotomy (n = 2). There was 1 operative death from sepsis following mediastinitis. When patients were divided into "broad" (n = 11) and "limited" (n = 7) groups, with the extent of LAC either greater or less than half of the left atrium, respectively, there was no intergroup difference in postoperative complications. During follow-up (median, 11.4 years), AF recurred in 11 patients. At the last follow-up visits, electrocardiography revealed significantly fewer patients in the broad group maintaining sinus rhythm (1/11 vs 4/6, P = 0.03). The 10-year AF recurrence-free survival rates were 13.9% and 66.7% in the broad and limited groups, respectively (P = 0.01).

CONCLUSIONS

The maze procedure combined with endoatriectomy seems technically feasible with acceptable long-term rhythm outcomes if the LAC extent is limited.

Computed Tomography as a Superior Diagnostic Test for Left Atrial Thrombus With Calcification

Left atrial (LA) thrombus with calcification is a rare anomaly in rheumatic mitral stenosis. An accurate preoperative evaluation is critical for making clinical decisions and surgical plans. This report describes a case of rheumatic heart disease in a patient who presented with the unusual imaging manifestation of massive LA thrombus with calcification. The precise anatomic features of massive LA thrombus with calcification were demonstrated by enhanced multidetector computed tomography.