Porcelain aorta (PA) is a structural aortic wall disease characterized by extensive heavy calcification of the ascending thoracic aorta extending to the aortic arch and descending aorta. The calcification occurs in a diffuse complete or near-complete circumferential pattern involving, predominantly, the ascending aorta's anterior wall and the aortic arch's superior wall.
The definition of porcelain aorta is not clear or standard, and it varied between authors who described it. The common denominator that best describes the clinical problem is aortic calcification that interferes with aortic cannulation, aortic clamping, aortotomy, or central coronary bypass anastomosis, necessitating modification of the surgical technique to avoid complications. The presence of PA complicates the successful performance of surgical and interventional procedures, and the aortic calcification has been associated with an increased risk of periprocedural complications and is an independent predictor of mortality in surgical patients.
Classification
Calcium deposition in porcelain aorta can be located in the tunica intima, starting at the base of atherosclerotic plaques, known as the atherosclerotic type. While in the non-atherosclerotic type, calcification usually occurs in the tunica media of the aortic wall.
Furthermore, porcelain aorta can also be classified into two main types based on the site of calcification in the thoracic aorta as follows:
Type I - implies the localization of circumferential calcification of the ascending aorta independent of further extensions. This type is subdivided into two subtypes according to assessing the aorta's clamping possibility during cardiac surgery by a calcification score proposed by Nishi et al. and defined as the ratio of the circumferential length of calcification to the entire ascending aortic circumference.
Type IA in which the calcification score is above 75%, impeding the possibility of aorta clamping during cardiac surgeries
Type IB shows a calcification score below 75%, allowing the option to clamp the aorta but with increased risk
Type II - refers to the calcification localized only in the aortic arch and descending aorta.
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