SPONTANEOUS CALCIFIC EMBOLIZATION ASSOCIATED WITH CALCIFIC AORTIC STENOSIS

The role of echocardiography in the investigation of focal cerebral ischaemia

One-hundred and ten patients referred for echocardiography to exclude a cardiac source of cerebral emboli were prospectively studied. Four patients with known cardiac abnormalities, for which they were receiving inadequate anticoagulation, were excluded from the study, and 18 patients were subsequently found to have a non-embolic cause for their cerebral pathology. Twenty-eight patients with a normal clinical examination, chest X-ray and electrocardiogram, and 27 patients with hypertension alone had echocardiograms which did not reveal a cardiac source of embolus. Of the remaining group of 33 patients, six were found to have a probable cardiac source of embolus and nine had abnormalities which may be associated with cerebral emboli. Echocardiography may not be indicated in patients with a normal clinical examination, chest X-ray and electrocardiogram, and in patients with hypertension alone. However, if these patients are excluded echocardiography gives a high yield of positive findings which may be of practical importance in the management of the patient.

Calcium emboli to the retinal artery in calcific aortic stenosis

It is generally appreciated in the cardiovascular literature that calcium emboli to a central retinal artery or its branches may be the presenting feature of otherwise uncomplicated calcific aortic stenosis. The ophthalmologic literature provides good evidence for this point. Over a 7-month period, four such cases have come to our attention. Other potential sources of emboli were excluded by standard noninvasive and invasive diagnostic techniques, and two patients underwent successful aortic valve replacement. Previous studies of calcific aortic stenosis have demonstrated postmortem histologic evidence of calcium emboli to various organs, for example, heart, kidney, or brain. Since these emboli are small, their occurrence is clinically silent. The retinal circulation is unique in that its occlusion by a calcium microembolus results in loss of vision, and this symptom may be a clue to the presence of calcific aortic stenosis.

Spontaneous calcific coronary embolisation: necropsy x-ray study

Thirty-one hearts with advanced calcification of one or both left heart valves were investigated for the presence of spontaneous calcific emboli. X-ray (Mammograf) showed coronary emboli in 14 cases, that is, in 45% of the whole series. In seven cases (23%) calcific particles were also present in the left ventricular cavity. A total of 265 calcific emboli (205 intracoronary plus 60 intravenous) was demonstrated. The embolisation occurred most frequently and most extensively in association with postrheumatic mitral valve disease. Coronary calcific embolisation must be considered in the differential diagnosis of symptoms of ischaemic heart disease in patients suffering from valvular heart lesions.

Diagnosis and treatment of aortic valve stenosis

The present review has attempted to summarize the classic symptoms and signs of aortic valve stenosis, especially in an adult. It is emphasized that all the classic signs rarely are present and their absence may mislead an unwary clinician. The diagnostic help provided by noninvasive tests, including echocardiography and phonocardiography, has been emphasized. A need for cardiac catheterization and angiography in most patients prior to corrective surgery is stressed. The natural history of the disease without operative intervention is dim and a significant risk of sudden death exists. The current surgical approach with immediate and long-term results is summarized. Finally, attention has been drawn to the special clinical circumstances when the aortic valve stenosis provides a strinkingly different clinical picture. We cannot find a better way to end this review than by quoting a warning note given by Thomas Lewis in 1920: "It is the faint cry of an anguished and fast failing muscle, which, when it comes, all should strain to hear, for it is not long repeated. A few months, a few years at most, and the end comes."

Monocular blindness secondary to calcific embolization. An unusual presentation of rheumatic mitral valvular disease

This report of a patient with systemic calcific embolization resulting in nonocular blindness represents an unusual presentation and complication of mitral valvular disease.