Images in Clinical Medicine
Coronary-Artery Calcification
N Engl J Med 2002; 347:1584November 14, 2002
- Article
Figure 1 A 78-year-old man with long-standing end-stage renal failure and a previous mitral-valve replacement presented with a one-month history of episodes of effort-related syncope. Results of physical examination and echocardiography were consistent with the presence of severe aortic stenosis. At coronary angiography, striking calcification of the left coronary artery outlining the major coronary vessels was evident on initial fluoroscopy (Panel A). Selective coronary angiography (Panel B) revealed severe left main-stem disease (arrow) and diffuse left and right coronary artery disease. Although coronary-artery calcification is common, even in young patients who are undergoing dialysis, the relation between atherosclerosis and vascular calcification is poorly understood. Recent data show that despite the calcific nature of coronary artery disease, both coronary-artery bypass surgery and angioplasty can be successfully undertaken in patients with renal failure, albeit with an increase in risk.
Saib S. Khogali, M.B., Ch.B.
Jonathan N. Townend, M.D.
Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom
