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INTRODUCTION -
Brief overview of CRAO, standard etiologies (carotid atherosclerosis, cardiac sources), urgency of diagnosis and limited retinal ischemia time.
Note rarity of calcific aortic valve disease presenting as retinal embolization, particularly in younger patients.
CASE PRESENTATION -
Patient demographics: 30-year-old male, smoker (7.5 pack-years), prior alcohol use, otherwise healthy.
Presenting complaint: sudden, painless loss of vision in the left eye.
Relevant history: transient chest pain 2 weeks prior; family history notable for bicuspid aortic valve and coarctation
*Corresponding Author: Hamad madi. Hamad Madi, MD, Department of Cardio Palestine. Email: [email protected]. Received: 11-May-2026, Manuscript No. AOTS - 5747; Editor Assigned: 12-MayDOI: 10.52338/aots.2026.5747. Citation: Hamad madi. Retinal Artery Embolization: A Rare Presentation Of Calc doi: 10.52338/aots.2026.5747. Copyright © 2026 Hamad madi. This is an open access article distributed und distribution, and reproduction in any medium, provided the original work is pro
N 3064-7517
ion: A Rare Presentation c Valve Stenosis.
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llah, West Bank, Palestine.
emergency most commonly related to carotid atherosclerosis or cardiac mon source of retinal emboli and rarely presents first as CRAO. history presented with sudden, painless, complete left monocular vision ngiography confirmed left central retinal artery occlusion with preserved ain. Cardiac examination revealed a harsh grade III/IV systolic ejection ypertrophy and anterior ST elevation. Transthoracic echocardiography mHg), markedly calcified valve with poorly visualized cusps, concentric ng aortic dilation (4.3 cm). Coronary angiography revealed ostial right racranial arterial occlusion. The patient underwent urgent surgical aortic c bicuspid aortic valve with large friable calcific vegetations at the fused stoperative recovery was uneventful; no further systemic embolic events
spid aortic valve disease in a young adult, manifesting as CRAO. Retinal rterial circulation. Identification of a cardiac source—particularly heavily can be bilateral. Urgent cardiac evaluation and consideration of valve ations are borderline, given the embolic risk. enosis. In young patients with retinal artery occlusion, prompt cardiac where indicated, catheterization) should be undertaken. Urgent valve zation.
rtic stenosis; bicuspid aortic valve; valve replacement; calcium embolus.
in father. -
Examination: left monocular vision loss with afferent pupillary defect, normal extraocular movements and anterior segment exam; grade III/IV harsh systolic ejection murmur at RUSB with carotid radiation.
Investigations -
Ophthalmology: Dilated fundus exam — pale retina with cherry-red spot; possible visible arteriolar embolus. Fluorescein angiography — absence of retinal arterial filling except cilioretinal artery; delayed venous filling.
ECG: sinus rhythm, LV hypertrophy, ST elevation V1–V4.
Transthoracic
echocardiogram:
moderate–severe
aortic stenosis (mean gradient ≈40 mmHg), markedly calcified valve with probable bicuspid morphology, concentric LV hypertrophy (wall thickness 1.9 cm), LVEF
othoracic Surgery, Palestine Medical Complex, Al-Ahli Hospital St, Ramallah, WB,
-2026 ; Reviewed: 01-June-2026, QC No. AOTS - 5747 ; Published: 08-June-2026.
cific Bicuspid Aortic Valve Stenosis. Annals of Thoracic Surgery. 2026 June; 17(1).
der the Creative Commons Attribution License, which permits unrestricted use, operly cited.
Hamad madi
60%, normal aortic root (3.5 cm). -
CT chest: ascending aorta dilation 4.3 cm.
Coronary angiography: ostial right coronary artery stenosis; otherwise normal coronaries.
Brain CT/MRI/MRA: no intracranial arterial stenosis or aneurysm; supra-aortic carotids normal.
*** Treatment -
Multidisciplinary decision for urgent surgical aortic valve replacement due to risk of recurrent embolization from friable calcific valve.
Intraoperative findings: severely stenotic bicuspid aortic valve with large, friable calcific vegetations at fused raphe between left and right cusps.
Procedure: mechanical aortic valve implantation; no intraoperative complications.
**Outcome and Follow-up -
Uneventful postoperative recovery; no further embolic events.
Ophthalmic prognosis: persistent visual loss in affected eye consistent with CRAO; cilioretinal-sparing limited central vision.
Cardiac follow-up: routine postoperative surveillance and anticoagulation per mechanical valve protocol.
DISCUSSION -
Emphasize rarity of CRAO as initial manifestation of calcific aortic valve disease, particularly in a young adult.
Pathophysiology: calcium microemboli from a heavily calcified, friable valve travel to retinal circulation; unique vulnerability of retinal end-arterial circulation leads to overt visual loss even when emboli would be clinically silent elsewhere.
Diagnostic approach: in CRAO—urgent ophthalmic investigations plus systemic embolic workup including carotid imaging and cardiac evaluation (echo ± TEE, CT/ CATH as indicated). In young patients or when embolic material appears calcific (white), consider aortic valve calcification as a source.
Management implications: While valve replacement is typically guided by hemodynamics and symptoms, embolic events from valvular calcification represent a valid indication for prompt surgical intervention to prevent recurrent, potentially bilateral embolization.
Literature context: summarize briefly that reported cases are few; existing reports support valve surgery in similar settings.
Limitations: single case; visual outcome limited due to delayed retinal reperfusion window.
CONCLUSION CRAO can be the presenting manifestation of calcific bicuspid aortic valve disease. Prompt cardiac evaluation and consideration of urgent valve replacement are warranted to prevent recurrent embolic events, even when classical surgical indications are marginal. Figure 1. Fundus photograph — pale retina with cherry-red spot (left eye).
Figure 2. Fundus showing segmented/narrowed arterioles and visible embolus (if present).
Hamad madi
Figure 3. Fundus showing segmented/narrowed arterioles and visible embolus (if present).
Figure 4. Fluorescein angiogram — early phase showing absent retinal arterial filling except cilioretinal artery; delayed venous filling.
REFERENCES 1.
Hayreh SS. Central retinal artery occlusion. Indian J Ophthalmol. 2018;66(12):1684–1695. doi:10.4103/ijo. IJO_1861_18
Biousse V, Calvetti O, Newman NJ. Retinal artery occlusion: acute management and treatment. Curr Opin Ophthalmol. 1998;9(6):45–54.
Chang HM, Lee T, Park SJ, et al. Calcific aortic valve disease and systemic embolization: case reports and review. Clin Cardiol. 1996;19(3):219–224. doi:10.1002/ clc.4960190322
Brown GC, Magargal LE. Central retinal artery occlusion: visual outcome after treatment. Am J Ophthalmol. 1981;92(4):541–547.
Hayreh SS, Zimmerman MB. Central retinal artery occlusion:
visual
outcome.
Ophthalmol.
2006;142(6):986–987. doi:10.1016/j.ajo.2006.07.015
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