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

• Lee HU
• Youn HJ
• Shim BJ
• Lee SJ
• Park MY
• Jeong JU
• Gu GM
• Jeon HK
• Lee JE
• Kwon BJ

• KMID: 2177407
• DOI: http://doi.org/10.4250/jcu.2012.20.4.193

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

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  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.

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  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.

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  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).

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

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