A 70-year-old woman, who had a history of a percutaneous transvenous mitral commissurotomy for rheumatic heart disease 34 years previously, was admitted with progressive right heart failure. Massive calcification of the left wall was observed on multidetector CT. She underwent a mitral valve replacement, tricuspid annuloplasty and permanent pacemaker implantation. Massive calcification of the left atrial wall is a rare condition, and constitutes a major complication and risk to mitral valve surgery because of the difficulty in entering the left atrium, potential embolization, and impaired hemostasis.

We report a case of vascular parkinsonism mainly treated at the patients' home with thyrotropin-releasing hormone (TRH). The patient was a 77-year-old male who had an attack of cerebral bleeding in the left posterior lobe in 1990. Thereafter, dysarthria, dysphagia and gait disturbance gradually developed. He had rigidity in the neck, and upper and lower extremities, but no tremor, and walked with short strides (marche a petit pas). We diagnosed the case as vascular parkinsonism, by his history and those symptomes.
We treated him mainly at his home since 1994. At first, we used combinations of levodopa, bromocriptine, amantadin, and anti-chorinergic drugs, but symptomes and signs of vascular parkinsonism did not disappear.
Finally, we used TRH 0.5 mg by an intravenous or intramuscular injection for 10-14 days a month. Thereafter, he became able to eat, speak and walk a little more, and we continued this therapy for about one year. He died in 1996 of asphyxia at a meal. We think TRH was effective for chronic stage of vascular parkinsonism even if treated at home.