Aortic Calcification in a Long-Term Warfarin Patient

BACKGROUND: Arterial calcification commonly complicates atherosclerosis but may also occur with prolonged warfarin use, explained by protein-mediated mechanisms. CASE SUMMARY: A 45-year-old Black woman with rheumatic mitral valve disease diagnosed at 23 years of age presented with NYHA functional class III symptoms. The medical record at the time of diagnosis reported severe mitral stenosis with moderate regurgitation on transthoracic echocardiography, but the original images and quantitative measurements were unavailable. She underwent balloon mitral valvuloplasty with limited benefit, then mechanical mitral valve replacement, required frequent dose adjustment to maintain therapeutic international normalized ratio (reported 14 mg/wk). Later, computed tomography showed thoracoabdominal calcification consistent with porcelain aorta. DISCUSSION: Inflammatory arterial diseases, including atherosclerosis, commonly cause vascular calcification. Prolonged use of warfarin may also contribute by inhibiting vitamin K-dependent protective pathways, promoting arterial wall calcification. TAKE-HOME MESSAGE: Porcelain aorta may be associated with prolonged use of vitamin K antagonists, such as warfarin, in addition to traditional risk factors.