A rare radiodiagnostic finding: totally and severely calcified aorta-the Porcelain aorta/Nadir bir radyodiyagnostik bulgu: butunuyle ve ciddi sekilde kalsifiye aorta-Porselen aorta.

An octogenarian male was referred to our department with effort angina refractory to optimal medical therapy. He had also relatively recurrent episodes of unstable angina pectoris. His physical examination was unremarkable. The electrocardiogram revealed non-specific ST segment and T wave changes. The chest X-ray showed a calcific ring at arcus aorta level. Then the patient was referred to catheterization laboratory for selective coronary angiography. During catheterization we realized that the entire aorta, from the iliac bifurcation to aortic cusps, had severe calcification resembling a porcelain tube (Fig.1, Video 1. See corresponding video/movie images at www.anakarder.com). In addition, selective coronary angiography showed atherosclerotic stenotic segments of the major epicardial coronary arteries.

Atherosclerosis and calcification are related conditions. The more calcification, the more atherosclerosis and vice versa. Atherosclerotic plaques and areas of calcification of the aorta are relatively common in the elderly. However complete and severe calcification of the entire aorta is a rare condition. Actually, this is a clinically silent pathology. On the other hand during aortic valve replacement or coronary artery bypass surgery (CABG), rigidity of the aorta becomes a problem causing cerebral embolization and cerebrovascular accident. The operative management of a patient with porcelain aorta is often difficult and complex. Due to an unclampable aorta, aortic no-touch techniques, such as in situ arterial grafting without cardiopulmonary bypass (off-pump CABG), apicoaortic conduit, endoaortic balloon or Foley catheter occlusion, and aortic valve replacement under profound hypothermic circulatory arrest are different surgical options.

In conclusion, a surgeon who encounters a porcelain aorta at operation must quickly choose a safe and suitable operative method. So, a cardiologist might detect the calcification of the aorta and inform the surgeon about it before the operation.

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Serkan Cay

Department of Cardiology, Yuksek Ihtisas Heart Education and Research Hospital, Ankara, Turkey

Address for Correspondence/Yazisma Adresi: Dr. Serkan Cay, Oba Sokak 11/6 Hurriyet Apt. Cebeci 06480, Ankara, Turkey Phone: [phone] Mobile: [phone] Fax: [phone] E-mail: [e-mail]