Calcified cerebral embolism due to aortic valve calcification
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IMAGES IN NEPHROLOGY
Calcified cerebral embolism due to aortic valve calcification Takashin Nakayama1 · Shu Wakino1 · Hiroshi Itoh1 Received: 28 May 2020 / Accepted: 18 June 2020 © Japanese Society of Nephrology 2020
Keywords Hemodialysis · Calcified cerebral embolism · Aortic valve calcification A 70-year-old man with end-stage diabetic kidney disease was admitted to our hospital to undergo construction of an arteriovenous shunt for hemodialysis. His medical history was significant for aortic stenosis. Preoperative echocardiography incidentally revealed a mass with high mobility on the calcified aortic valve, which had not been found 5 months before (Fig. 1a, b). Urgent aortic valve replacement revealed the mass was derived from aortic valve calcification (AVC). There were no findings of infection or neoplasia. The patient did not recover consciousness after surgery, and computed
tomography showed calcified cerebral embolus (Fig. 1c). It was likely that a part of the mass entered the brain before the resection was completed. AVC is prevalent among patients with chronic kidney disease [1]. Although AVC proverbially leads to aortic valvular dysfunction, it also rarely remains one of the sources of calcified cerebral emboli (CCE) [2]. Physicians should pay attention to CCE associated with AVC, particularly in patients with progressive chronic kidney disease.
Fig. 1 Transesophageal echocardiography showing a highly mobile mass (arrows) on the right coronary cusp (a two dimensions, b three
dimensions). Computed tomography showing a calcified embolus (arrow) in the left middle cerebral artery with the territory infarction (c)
* Shu Wakino [email protected] 1
Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku‑ku, Tokyo 160‑8582, Japan
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Clinical and Experimental Nephrology
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References
Conflict of interest The authors have declared that no conflict of interest exists.
1. Marwick TH, Amann K, Bangalore S. Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019;96:836–49. 2. Bardon M, Hanson J, O’Brien B, Naeem A. Calcified cerebral emboli: incidence and implications. J Med Imaging Radiat Oncol. 2018;62:499–503.
Human and animal rights This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent Informed consent for publication has been obtained from the patient’s family because the consciousness of the patient was impaired.
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