Abstract
Background:Caseous calcification of the mitral annulus (CCMA) is believed to have a benign prognosis. Several authors have recommended conservative management in asymptomatic patients. However, the prevalence of cerebrovascular events (CVE) in patients with CCMA has never been evaluated before. The aims of this study are to investigate whether patients with CCMA are at increased risk of cerebral embolization, and to determine whether elective surgical resection of CCMA should be considered to prevent a cardioembolic stroke.Methods:A comprehensive literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, and Google Scholar using the following search queries: caseous calcification of the mitral annulus, intracardiac pseudotumor, mitral annular calcification, and cardioembolic stroke.Results:From our initial search that yielded 1,502 articles, we identified a total of 130 patients with CCMA reported in 86 publications. Literature review revealed that the prevalence of CVE associated with CCMA is 19.2% (25 of 130) which is significantly higher than the prevalence of CVE reported with mitral annular calcification (MAC), 11.8% (214 of 1818) (range 4.8% to 24.1%) (P = 0.01796) (odds ratio = 1.78; 0.95 confidence interval = 1.1278 – 2.8239). Only four of 25 (16.0%) patients with CCMA who suffered a CVE had history of atrial fibrillation (AF).Conclusion: Based on our review, it would be reasonable to consider elective surgical resection of CCMA in asymptomatic patients who are good surgical candidates, because patients with CCMA may be at increased risk of embolic strokes, which are unrelated to AF.
Highlights
One-fifth of all ischemic strokes are cardioembolic
Based on our review, it would be reasonable to consider elective surgical resection of calcification of the mitral annulus (CCMA) in asymptomatic patients who are good surgical candidates, because patients with CCMA may be at increased risk of embolic strokes, which are unrelated to Atrial fibrillation (AF)
These include 57 publications on caseous calcification of the mitral annulus, 14 articles on liquefaction necrosis of the mitral annulus, 7 articles on mitral annular calcification that included patients with CCMA, and 8 papers on intracardiac pseudotumors that were included because the patients
Summary
One-fifth of all ischemic strokes are cardioembolic. Several cardiac conditions have been identified as potential sources of embolism. Atrial fibrillation (AF) is the most common cause of cardioembolic stroke. Caseous calcification of the mitral annulus, calcific aortic stenosis, patent foramen ovale, atrial or ventricular septal defects, and atrial septal aneurysm may be associated with cardioembolism [1]. The association between MAC and atrial fibrillation, cerebral embolization, acquired mitral stenosis, hypertension, hyperlipidemia, diabetes, coronary artery disease, aortic atheroma, and diffuse atherosclerosis has been well documented. According to several clinical and clinicopathologic studies [2 - 9], the risk of cerebrovascular events (CVE) in patients with MAC ranges from 4.8% to 24.1% (Table 1). The aims of this study are to investigate whether patients with CCMA are at increased risk of cerebral embolization, and to determine whether elective surgical resection of CCMA should be considered to prevent a cardioembolic stroke
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