J Cardiovasc Ultrasound.  2012 Dec;20(4):193-196. 10.4250/jcu.2012.20.4.193.

Porcelain Heart: Rapid Progression of Cardiac Calcification in a Patient with Hemodialysis

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Pohang St. Mary's Hospital, Pohang, Korea.
  • 2Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea. younhj@catholic.ac.kr
  • 3Department of Radiology, Pohang St. Mary's Hospital, Pohang, Korea.
  • 4Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Uijeongbu, Korea.

Abstract

Cardiac calcification usually occurs in patients with end-stage renal disease. However, rapid progression of cardiac calcification is rarely associated with secondary hyperparathyroidism of end-stage renal disease. We report a patient with end-stage renal disease who showed moderate left ventricular hypertrophy at the first echocardiography, and showed severe myocardial calcification and severe mitral valve stenosis 4 years later. We suspected a rapid progression 'porcelain heart' cardiomyopathy secondary to hyperparathyroidism of end-stage renal disease. The patient underwent parathyroidectomy, and considered mitral valve replacement.

Keyword

End stage renal disease; Secondary hyperparathyroidism; Myocardial calcification; Mitral valve stenosis

MeSH Terms

Cardiomyopathies
Dental Porcelain
Echocardiography
Humans
Hyperparathyroidism
Hyperparathyroidism, Secondary
Hypertrophy, Left Ventricular
Kidney Failure, Chronic
Mitral Valve
Mitral Valve Stenosis
Parathyroidectomy
Renal Dialysis
Dental Porcelain

Figure

  • Fig. 1 Changes of transthoracic echocardiography. The echocardiogram on parasternal long axis view shows moderate LVH in 2007 (A). Follow up echocardiogram shows extensive myocardial calcification (arrowhead) and severe mitral stenosis with a mitral valve calcification (arrow) in 2011 (B, C and D). LVH: left ventricular hypertrophy, LV: left ventricle, LA: left atrium.

  • Fig. 2 Cardiac CT (A-D) and peripheral CT (E and F) shows extensive calcification. Cardiac CT shows severe mitral valve calcification (arrow) and myocardial calcification (arrowhead, A), diffuse calcification of LAD coronary artery (B), LCX coronary artery (C) and RCA coronary artery (D). Non enhanced CT shows muscular calcification (arrow, E) and superficial femoral artery calcification (arrows, F). LAD: left anterior descending, LCX: left circumflex, RCA: right coronary artery.

  • Fig. 3 Microscopic findings. Histology exam shows parathyroid tissue with diffuse hyperplasia of chief cells (A: H&E stain, × 100; B: H&E stain, × 200).

  • Fig. 4 Change of Ca, P and PTH-I level after parathyroidectomy. PTH-I: immuno-reactive parathyroid hormone.


Reference

1. Raggi P, Boulay A, Chasan-Taber S, Amin N, Dillon M, Burke SK, Chertow GM. Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol. 2002. 39:695–701.
Article
2. Freeman J, Dodd JD, Ridge CA, O'Neill A, McCreery C, Quinn M. "Porcelain heart" cardiomyopathy secondary to hyperparathyroidism: radiographic, echocardiographic, and cardiac CT appearances. J Cardiovasc Comput Tomogr. 2010. 4:402–404.
Article
3. Aras D, Topaloglu S, Demirkan B, Deveci B, Ozeke O, Korkmaz S. Porcelain heart: a case of massive myocardial calcification. Int J Cardiovasc Imaging. 2006. 22:123–126.
Article
4. Kempf AE, Momeni MG, Saremi F. Myocardial calcinosis in chronic renal failure. J Radiol Case Rep. 2009. 3:16–19.
5. London GM, Guérin AP, Marchais SJ, Métivier F, Pannier B, Adda H. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant. 2003. 18:1731–1740.
Article
6. Fraser WD. Hyperparathyroidism. Lancet. 2009. 374:145–158.
Article
7. Wang AY, Ho SS, Wang M, Liu EK, Ho S, Li PK, Lui SF, Sanderson JE. Cardiac valvular calcification as a marker of atherosclerosis and arterial calcification in end-stage renal disease. Arch Intern Med. 2005. 165:327–332.
Article
8. Kuzela DC, Huffer WE, Conger JD, Winter SD, Hammond WS. Soft tissue calcification in chronic dialysis patients. Am J Pathol. 1977. 86:403–424.
9. Isotalo PA, Halil A, Green M, Tang A, Lach B, Veinot JP. Metastatic calcification of the cardiac conduction system with heart block: an under-reported entity in chronic renal failure patients. J Forensic Sci. 2000. 45:1335–1338.
Article
10. Parfrey PS, Foley RN. The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol. 1999. 10:1606–1615.
Article
11. Moe SM, Chen NX. Mechanisms of vascular calcification in chronic kidney disease. J Am Soc Nephrol. 2008. 19:213–216.
12. Maher ER, Young G, Smyth-Walsh B, Pugh S, Curtis JR. Aortic and mitral valve calcification in patients with end-stage renal disease. Lancet. 1987. 2:875–877.
Article
13. Fujise K, Amerling R, Sherman W. Rapid progression of mitral and aortic stenosis in a patient with secondary hyperparathyroidism. Br Heart J. 1993. 70:282–284.
Article
14. Massry SG, Smogorzewski M. Management of vascular calcification in CKD patients. Semin Nephrol. 2006. 26:38–41.
Article
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