Caseous calcification of the mitral annulus.
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ABSTRACT:
SUBMITTER: Arora H
PROVIDER: S-EPMC2435443 | biostudies-literature | 2008
REPOSITORIES: biostudies-literature
Publications
Caseous calcification of the mitral annulus.
Arora Harvinder H Madan Pankaj P Simpson Leo L Stainback Raymond F RF
Texas Heart Institute journal 20080101 2
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Project description:Mitral annular calcification (MAC) is considered a chronic and degenerative process involving the fibrous annulus of the mitral valve. The prevalence of MAC has been reported between 8% and 15%. It significantly increases with age, often seen in females, individuals with hypertension, chronic kidney disease and those with multiple cardiovascular risk factors. Caseous calcification of the mitral annulus (CCMA) (also known as caseoma) is a rare variant of MAC and should be considered in the differential diagnosis with other cardiac masses of the mitral valve. An 85-year-old female presented for a transthoracic echocardiogram with a history of hypertension and a systolic murmur. The echocardiogram demonstrated a possible rare variant of MAC, with independent mobile echodensities identified. Further testing using transoesophageal echocardiography was used to confirm diagnosis and ensure appropriate clinical management was arranged. This case demonstrated CCMA, a benign condition that can be mistaken for cardiac tumours, thrombus, vegetations or abscesses. A low prevalence has been reported between 0.06% and 0.07% and 0.6% of patients with MAC using echocardiography. Echocardiography can provide the initial diagnosis for identification and characterisation of MAC. CCMA appears as a calcified mass with an echolucent, liquid-like inner part, located on the posterior mitral valve annulus. Acoustic shadowing is usually absent. Multi-modality imaging can lead to an accurate diagnosis of CCMA without unnecessary interventions. Transoesophageal echocardiography provides further information on the site and composition of the internal material. Computed tomography (CT) and cardiac magnetic resonance imaging (MRI) can also be used, to confirm the diagnosis and to exclude other differential diagnoses.
| S-EPMC8412006 | biostudies-literature
Project description:A 68-year-old woman presented with an incidentally found intracardiac mass. Transesophageal echocardiography (TEE) showed a 26 × 8 mm mobile mass attached to a calcified posterolateral mitral annulus. The mass was removed with a commercially available percutaneous catheter system using cerebral embolic protection and TEE guidance. The pathologic examination showed caseous mitral annular calcification.
| S-EPMC10865118 | biostudies-literature
Project description:BackgroundCaseous calcification of the mitral annulus (CCMA) is a very rare variant of mitral annular calcification, which is typically asymptomatic but can manifest as a cardiac tumour, abscess, or in the form of mitral valve dysfunction.Case summaryWe present a patient who developed shortness of breath and was initially thought to have an intracardiac tumour, but ultimately was recognized as massive calcification of the mitral valve by computed tomography angiogram. This finding was unfortunately made only shortly before the patient's clinical deterioration, and the specific diagnosis of CCMA was made on post-mortem findings, precluding any directed treatment for this entity.DiscussionCaseous calcification of the mitral annulus can lead to significant pathology, including mitral regurgitation, stenosis, or systemic embolization of caseous material. Due to its relative scarcity and tendency to be asymptomatic, a diagnosis of CCMA is often difficult to make or easily overlooked. Early recognition and appropriate treatment is crucial for avoiding these potential complications.
| S-EPMC6426072 | biostudies-literature
Project description:BackgroundCaseous calcification of the mitral annulus is an extremely rare variant of mitral annulus calcification occurring in <1% of cases. The degeneration of caseous masses could act as a source of embolic strokes and a nidus for infective endocarditis (IE).Case summaryA man in his sixties presented with transient left arm weakness. His history was pertinent for bioprosthetic aortic valve replacement secondary to endocarditis and recent pneumococcal pneumonia complicated by empyema and bacteraemia. He was still on intravenous antibiotics when he presented. Evaluation including magnetic resonance imaging of the brain, transoesophageal echocardiography, and computed tomography (CT) of the chest revealed multifocal embolic strokes, degenerative bioprosthetic aortic valve dysfunction, mitral annular calcification with mobile calcific masses, and persistent empyema. 18F-fluorodeoxyglucose-positron emission tomography-CT showed indeterminate activity across a portion of the posterior mitral leaflet and no activity on the bioprosthetic aortic valve. The patient was deemed high risk for surgery and was treated with 6-week course of antibiotics both for the empyema and the possible IE of the native mitral valve. Repeat echocardiography 40 days later showed stable mitral masses. At 4 months of follow up, the patient had no evidence of recurrent clinical strokes.DiscussionCaseous calcification of the mitral annulus is a rare but an increasingly recognized predisposing factor for embolic strokes and IE. Treatment ideally involves surgical resection of the calcified masses in such cases.
| S-EPMC9675592 | biostudies-literature
Project description:Highlights•Mitral annular calcification (MAC) is a common echocardiographic finding, estimated at around 14%, and occurs especially in elderly women.•Caseous calcification of the mitral annulus (CCMA) is a rare subvariant of MAC, with an echocardiographic prevalence of 0.6% and necropsy prevalence of about 2.3%.•CCMA, just like MAC, is believed to be associated with a high calcium score, coronary artery disease, aortic valve disease, atrial fibrillation, and hypertension.•CCMA can be confused echocardiographically with infective endocarditis, tumors, and cysts.•The decision for surgical treatment of CCMA is based on clinical judgment with factors such as valvular dysfunction and/or the propensity for stroke.
| S-EPMC6034490 | biostudies-other
Project description: Not available
| S-EPMC9556935 | biostudies-literature
Project description:Mitral annular calcification (MAC) is a chronic, degenerative condition of the fibrous mitral annulus, which may transform to liquefaction necrosis MAC, a rare variant of caseous MAC. We present a series of experiences, showing the varying manifestations of caseous MAC according to multimodal imaging. (Level of Difficulty: Intermediate.).
| S-EPMC8305068 | biostudies-literature
Project description:BackgroundCaseous calcification of the mitral annulus (CCMA), a subtype of mitral annulus calcification, is rarely encountered. Although most cases of CCMA are asymptomatic and have a benign course, there are several reports of mitral valve dysfunction, stroke, and myocardial infarction. However, few reports have been published on conduction disturbances.Case summaryWe encountered a case of an atrioventricular block, which is a rarely reported complication, in a 70-year-old woman who presented with heart failure. The patient's anatomy suggested a conduction disturbance caused by CCMA extending from the posterior apex of the mitral annulus to the ventricular septum. Our heart team discussed whether surgical resection should be performed. We concluded that bradycardia was the most likely cause of the current symptoms and that resection of the extensively infiltrated calcification was risky; therefore, we decided to proceed with pacemaker implantation followed by careful observation of the mass. The patient had undergone permanent pacemaker implantation and has been asymptomatic ever since.DiscussionFew reports on conduction abnormalities caused by CCMA have been published. A mass involving the left ventricular septum and posterior mitral annulus may lead to conduction abnormalities, such as a complete atrioventricular block, in the future. We suggest that careful follow-up is required for CCMA, as it has been determined that surgical intervention is not required.
| S-EPMC11879389 | biostudies-literature
Project description:BackgroundCalcified amorphous tumour (CAT) is a rare lesion that forms at various sites of the heart, including the mitral annulus. Since it is a systemic embolic source, it often requires resection. In contrast, caseous calcification of the mitral annulus (CCMA) usually receives conservative follow-up; however, it is sometimes resected to prevent embolism. Herein, we present a rare case of CCMA-associated CAT with chronic inflammatory cardiomyopathy and comprehensively consider the aetiology of CCMA-associated CAT.Case summaryA 52-year-old man with end-stage renal failure requiring haemodialysis underwent annual follow-up echocardiography for aortic valvular dysfunction. Echocardiography revealed a well-defined 22 × 17-mm circular mass on the annulus of the posterior mitral leaflet that had not been detected 2 years previously. Based on imaging characteristics, the mass was suspected to be a CCMA. It had rapidly enlarged and posed a potential risk for embolism; therefore, it was resected concurrently with aortic valve replacement. Although CCMA was suspected based on the intraoperative findings, the histopathological diagnosis was a CAT. Upon histological analysis of the left ventricular myocardial specimen and excised aortic valve, chronic inflammatory cell infiltration was observed; therefore, chronic inflammatory cardiomyopathy was diagnosed.DiscussionIn this case, the timing of decreased left ventricular systolic function and the arising mass coincided, suggesting that chronic inflammation and immunopathological reactions may have influenced the development of CAT from CCMA. Therefore, the rapid progression of CCMA in the development of CAT should especially be considered in patients with inflammatory cardiac comorbidities.
| S-EPMC11886802 | biostudies-literature
Project description: Not available
| S-EPMC10195709 | biostudies-literature