Mitral Regurgitation Due to Caseous Calcification of the Mitral Annulus

Donovan Tran,Colin Zuchowski

doi:10.7759/cureus.11402

Donovan Tran, Colin Zuchowski

Open Access

https://doi.org/10.7759/cureus.11402

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Journal: Cureus	Publication Date: Nov 9, 2020
Citations: 1	License type: cc-by

Affiliation: University of Arizona, Emory University

Abstract

Mitral regurgitation can be a debilitating disease that has many etiologies. Frequent causes are mitral valve prolapse, rheumatic fever, dilated cardiomyopathy, and infective endocarditis. Another rare, but often overlooked cause is caseous calcification of the mitral annulus. This rare disease can lead to dangerous complications such as stroke and arrhythmias. In this report, we present an 84-year-old male with chronic kidney disease who was found to have mitral regurgitation secondary to caseous calcification of the mitral annulus. The goal of this report is to bring clinical awareness to this disease so that it is included in the differential diagnosis of mitral regurgitation.

Highlights

Caseous calcification of the mitral annulus, known as mitral annular caseoma, is a form of mitral annular calcification. This cardiac mass is often incidentally found on echocardiogram or computed tomography (CT) imaging
He had a medical history of mitral regurgitation, chronic kidney disease, severe coronary artery disease requiring coronary artery bypass grafting, and heart failure with preserved ejection fraction of 65%
Caseomas occur in 0.6% of patients with mitral annular calcification [3]

Summary

Introduction

Caseous calcification of the mitral annulus, known as mitral annular caseoma, is a form of mitral annular calcification This cardiac mass is often incidentally found on echocardiogram or computed tomography (CT) imaging. An 84-year-old male presented to the cardiothoracic surgery clinic to discuss options to treat his severe mitral regurgitation, as his dyspnea had slowly been worsening. Contrast-enhanced coronary CT showed global cardiomegaly with severe dilatation of the left atrium and eccentric posterior mitral annular calcification with a hypodense central region. These findings were highly suspicious for a caseoma (Figures 1-3).

Discussion

Conclusions

Disclosures