Porcelain aorta

Porcelain aorta

Diffuse calcification of ascending aorta which may extend down is known as “Porcelain aorta”. Calcified aorta has an egg shell like appearance. The dense calcification makes the ascending aorta unclampable during procedures requiring cardiopulmonary bypass like coronary artery bypass grafting and valve replacement. The calcification may be detected by chest-ray, CT scan and sometimes by echocardiography, usually transesophageal.

The calcification is also visible during fluoroscopy for coronary angiography. When such calcification is detected prior to aortic valve replacement, option of transcatheter aortic valve implantation may be considered. In case of coronary artery bypass grafting, off pump coronary artery bypass grafting which avoids aortic cross clamping is an option.

An image published in New England Journal of Medicine demonstrated prominent linear calcification along the thoracic aorta on chest X-ray. The patient was a middle aged lady who was referred for aortic valve surgery because of severe aortic regurgitation [1].

In another report, a 60 year old male who had undergone mantle radiation for Hodgkin’s lymphoma in 1968 presented with severe symptomatic aortic stenosis. Aorta was unclampable due to diffuse calcification. Chest X-ray showed calcification of ascending aorta and arch. Fluoroscopy showed severe anterior ascending aorta calcification, which was also detectable on transesophageal echocardiography and eminently demonstrated by computed tomography. He underwent percutaneous transfemoral aortic valve replacement as part of the PARTNER trial, with excellent result even though his STS score was low for a surgical valve replacement [2].

References

1. Kang MK, Ha JW. N Engl J Med. 2012 Jun 28;366(26):e40.
2. Michelena HI, Rihal CS, Enriquez-Sarano M. Eur Heart J. 2011 Sep;32(18):2303.