A CASE OF MITRAL STENOSIS WITH EXTENSIVE CALCIFICATION OF LEFT ATRIAL WALL

Abstract

A 64-year-old woman was admitted to a hospital because of cerebral infarction and rheumatoid arthritis in June, 1979. The chest X-ray revealed left atrial calcification and examination showed a heart murmur. She was admitted to our hospital for cardiac catheterisation in June, 1984. On admission, blood pressure was 124/66 mmHg, and pulse rate 66 per minute and irregular. Examination showed a diastolic murmur at the cardiac apex, no pulmonary rales and no edema, NYHA class III. E.C.G. showed atrial fibrillation and right bundle branch block. Chest CT scan revealed extensive calcification of left atrial wall. P.C.G. showed a diastolic rumble. U.C.G. showed decrease of mitral DDR, typical wave of mitral stenosis but no dilatation of left atrium. The cardiac catheterisation showed good contraction of left ventricule and an ejection fraction of 0.85, no contraction of left atrium and no motion of mitral valve. Hemodynamic parameters were within normal limits except cardiac index (1.8 l/min/m²) and pulmonary capillary wedge pressure (18 mmHg) . Coronary angiography showed triple vessel disease. It is necessary to discuss the influence of left atrial extensive calcification on hemodynamics.