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PULMONARY OSSIFICATION WITH CARDIAC CALCIFICATION IN MITRAL VALVE DISEASE

1957; BMJ; Volume: 19; Issue: 4 Linguagem: Inglês

10.1136/hrt.19.4.532

1468-201X

H A Fleming, C. L. N. Robinson,

Pulmonary Hypertension Research and Treatments

Our purpose is to present eight cases of mitral valve disease with disseminated pulmonary ossification, in seven of which there was also massive calcification of the mitral valve or left atrium or both.Of these five were seen by us at this hospital and are the only cases of pulmonary ossification in association with mitral valve disease that have been seen here up to the present: the other three were studied from their records.Pulmonary ossification is rare and cardiac calcification not common, and the combination of the two must be unusual.Wagner in 1859 first reported bone formation in the lungs in a woman aged 25 years with dropsy.Salinger (1932) first recognized the relation of bony nodules to mitral valve disease and reported a second case.Other reports have been made by Wells and Dunlap in 1943 (1 case) and by Grishman and Kane in 1945 (8 cases).Elkeles and Glynn (1946) described the first case in England.In 1947 Elkeles reported a further case in which the appearances are very different from all other cases: it would appear from the radiograph to be almost certainly a case of calcified pulmonary tuberculosis.Later reports have been made by Lawson (1949), Lendrum et al. (1950, 3 cases), Sahn and Levine (1950), Kerley, (1951), Schinz et al. (1953), Steiner and Good- win (1954, 2 cases), and Short (1955) (1 case each unless stated).In many of these reports the condition is referred to in passing, and the clinical and pathological details are often very few.Whitaker et al. (1955) presenting 7 new cases in detail, give an excellent review and a discussion of the aetiology.Calcification of the mitral valve is common in mitral valve disease and is recorded in all recent series.For example Wood (1954) reported some degree of calcification in 28 per cent of cases submitted to mitral valvotomy and heavy calcification in 50 per cent of those with a significant degree of mitral incompetence.Calcification of the left atrium was first described radiologically by Shanks et al. (1938).Ruskin and Samuel (1952) reviewed the only 18 cases they found described in life and added 2 new ones: they view it as a rare condition usually associated with mitral valve disease.The calcification is subendocardial and varies from isolated plaques in the posterior wall to involvement of the entire atrial wall, and in some cases the mitral valve was also calcified.Steiner and Goodwin (1954) men- tion 2 in a series of 91 cases.The relevant features of our cases are summarized in Table 1.All the patients except Case 4 were submitted to operation for mitral valvotomy. (Cases 1, 2, and 3 by Mr. Dillwyn Thomas, Case 5 by Mr. H. R. S. Harley, Case 7 by Mr. 0. S. Tubbs, and Cases 6 and 8 by Mr. Ian Hill.)In all the operated cases the areas of ossification could be easily felt in the lung substance.Case 1 (Fig. 3) is of interest in that the entire wall of the left atrium was calcified and this process extended along all the pulmonary veins so that no access to the mitral valve was possible by the accepted methods of the time.The calcium appeared to be within the wall rather than in thrombus.