Caseous Calcification Of Mitral Annulus Research Articles

PP-009 HUGE LEFT ATRIAL MYXOMA ORIGINATING FROM INTERATRIAL SEPTUM

PP-008 MULTIMODALITY IMAGING IN THE DIAGNOSIS OF CASEOUS CALCIFICATION OF MITRAL ANNULUS S. Demirkol, S. Balta, U. Bozlar, M. Unlu, A. Iyisoy, Z. Arslan, U. Kucuk, S. Sari, T. Celik. Department of Cardiology, Gulhane Medical Faculty, Ankara, Turkey; Department of Radiology, Gulhane Medical Faculty, Ankara, Turkey; Department of Cardiology, Beytepe Hospital, Ankara, Turkey; Department of Cardiology, Gelibolu Hospital, Canakkale, Turkey

Multi Modality Imaging for Cardiac Masses Can Avoid Unnecessary Surgical Intervention: A Case Report of Caseous Calcification of Mitral Annulus

Mitral Annular Calcification (MAC) is a degenerative process involving the fibrous ring of the mitral valve. Caseous Calcification of Mitral Annulus (CCMA) is a rare variant of MAC. This condition is benign and usually needs no treatment. This is a case report of a 67-year-old woman with non-specific symptoms in whom a cardiac tumor was suspected by transthoracic Echocardiography. The use of multi-modality imaging strategy with transesophageal Echocardiography and cardiac MR scanning revealed however the diagnosis of CCMA and spared the patient an unnecessary operation.

Multimodality imaging in the diagnosis of caseous calcification of mitral annulus

Multimodality imaging in the diagnosis of caseous calcification of mitral annulus

Into the Flames

HomeRadioGraphicsVol. 32, No. 6 PreviousNext DepartmentsIlluminationsInto the FlamesKai-hung FungKai-hung FungAuthor AffiliationsHong Kong, ChinaKai-hung FungPublished Online:Oct 4 2012https://doi.org/10.1148/rg.326125911MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished online: Oct 4 2012Published in print: Oct 2012 FiguresReferencesRelatedDetailsRecommended Articles Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR ImagingRadioGraphics2017Volume: 37Issue: 5pp. 1330-1351Mitral Valve Imaging with CT: Relationship with Transcatheter Mitral Valve InterventionsRadiology2018Volume: 288Issue: 3pp. 638-655Infectious Diseases of the Heart: Pathophysiology, Clinical and Imaging OverviewRadioGraphics2016Volume: 36Issue: 4pp. 963-983International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research PurposesRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 4The Relationship of Mitral Annulus Shape at CT to Mitral Regurgitation after Transcatheter Aortic Valve ReplacementRadiology2021Volume: 301Issue: 1pp. 93-102See More RSNA Education Exhibits Anatomic Considerations and Imaging of Mitral Valve Disease: Pertinent Imaging for Pre-Surgical PlanningDigital Posters2018Mitral Valve Prolapse and Annular Disjunction: State of the Art and Added Value of CMRDigital Posters2020A Beginner’s Guide to Understanding Echocardiography with CT/MRI Correlation, Case-based Examples, and Emphasis on Blind SpotsDigital Posters2019 RSNA Case Collection Caseous Mitral Annular Calcification RSNA Case Collection2022Hypertrophic cardiomyopathyRSNA Case Collection2020Papillary fibroelastomaRSNA Case Collection2020 Vol. 32, No. 6 Metrics Altmetric Score PDF download

Critical multi‐organ emboli originating from collapsed, vulnerable caseous mitral annular calcification

Mitral annular calcification (MAC) is a generally asymptomatic abnormality found commonly in aged hearts. Some clinical studies have suggested that MAC should be considered an independent risk factor for stroke; however, whether the abnormality is indeed a risk factor remains controversial. We report a case in which debris from a vulnerable caseous MAC contributed to lethal embolisms in multiple organs. Postmortem examination revealed that caseous materials originating from a collapsed MAC were trapped in stenosed atherosclerotic cerebral and coronary arteries. Our findings support the notion at that subtle debris from collapsed vulnerable MACs can trigger major and even lethal embolic events in patients with severe atherosclerotic stenosis in vital organs.

Caseous calcification of the mitral annulus: A multi-modality imaging perspective

Mitral annulus calcification is a common echocardiographic finding, particularly in the elderly and in end-stage renal disease patients under chronic dialysis. Caseous calcification or liquefaction necrosis of mitral annulus calcification is a rare evolution of mitral annular calcification. Early recognition of this entity avoids an invasive diagnostic approach, since it is benign and, unlike intracardiac tumors and abscesses, has a favorable prognosis. The authors present the case of an 84-year-old woman with a suspicious large, echodense mass at the level of the posterior mitral leaflet with associated severe mitral regurgitation. Cardiac magnetic resonance imaging demonstrated a hypoperfused mass with strong peripheral enhancement 10 minutes after gadolinium administration. Multislice computed tomography showed the calcified nature of the mass. A multi-modality imaging approach confirmed the diagnosis of caseous calcification of the posterior mitral annulus. The patient refused surgical treatment.

Caseous calcification of the mitral annulus: A multi-modality imaging perspective

Mitral annulus calcification is a common echocardiographic finding, particularly in the elderly and in end-stage renal disease patients under chronic dialysis. Caseous calcification or liquefaction necrosis of mitral annulus calcification is a rare evolution of mitral annular calcification. Early recognition of this entity avoids an invasive diagnostic approach, since it is benign and, unlike intracardiac tumors and abscesses, has a favorable prognosis. The authors present the case of an 84-year-old woman with a suspicious large, echodense mass at the level of the posterior mitral leaflet with associated severe mitral regurgitation. Cardiac magnetic resonance imaging demonstrated a hypoperfused mass with strong peripheral enhancement 10 minutes after gadolinium administration. Multislice computed tomography showed the calcified nature of the mass. A multi-modality imaging approach confirmed the diagnosis of caseous calcification of the posterior mitral annulus. The patient refused surgical treatment.

Caseous mitral annular calcification: Is it a benign condition?

Caseous mitral annular calcification (CMAC) is a variant of mitral annular calcification (MAC) with a central liquefaction necrosis. The echocardiographic prevalence of CMAC is approximately 0.6% in patients with MAC and 0.06–0.07% in large series of patients of all ages. However, the prevalence in necropsy series has been reported to be 2.7%, which indicates that this condition is yet under-recognized. Furthermore CMAC is probably underappreciated as a source of potentially serious conditions. We report a case of recent stroke associated with CMAC diagnosed by trans-thoracic and confirmed by trans-esophageal echocardiogram (TEE). The importance of correct diagnosis of CMAC extends beyond the possible complications; since several misdiagnoses of CMAC as abscesses and cardiac tumors have been reported leading to inappropriate interventions.

Mitral Valve Restoration in a Case of Destructive Caseous Annular Calcification Using a MitroFix Hybrid Prosthesis

The MitroFix device is a novel prosthesis consisting of an annuloplasty ring incorporating a rigid, porcine pericardium-lined posterior leafl et in the “closed” position. This device was used in a case of caseous mitral annular calcifi cation masquerading as an intracardiac tumor and was associated with severe valvular regurgitation due to loss of leafl et coaptation. Threedimensional transesophageal echocardiography gives an accurate and comprehensive assessment of the postoperative hybrid repair. The repair involved resection of the posterior leafl et masquerading as an intracardiac tumor but preserving the posterior mitral valve. This prosthesis restored the coaptation and competence of the mitral valve.

Diagnosis of a caseous mitral annular calcification

Diagnosis of a caseous mitral annular calcification

Multimodality imaging of caseous calcification of mitral annulus

A 73-year-old woman presented with sinoatrial block. Transthoracic echocardiography revealed a tumor-like mass (2.5 cm × 3.0 cm) located in the mitral annulus (Fig. 1(A)). Caseous calcification of the mitral annulus was suspected, which was supported by computed tomography (CT) and magnetic resonance imaging (MRI) (Fig. 1 (B-D)). Mitral valve replacement was performed using a 25-mm Mosaic Ultra bioprosthesis (Fig. 2 (A and B)).

Caseous Calcification of the Mitral Annulus, a Rare Echocardiographic Finding

Caseous calcification of mitral annulus, also known as caseoma, is a rare echocardiographic finding. Because it often presents asymptomatically, the diagnosis is usually incidental. The condition arises due to caseous degeneration in the internal material of the mitral annulus calcification. On echocardiography, the calcification is a round mass with a central echolucent area, typically located at the base of the posterior leaflet, and can be mistaken for cardiac tumors or abscesses. We describe 3 patients with the condition, one of whom required surgical removal of the mass to obtain a definitive diagnosis.

Calcificación caseosa del anillo mitral, un raro hallazgo ecocardiográfico

Caseous calcification of mitral annulus, also known as caseoma, is a rare echocardiographic finding. Because it often presents asymptomatically, the diagnosis is usually incidental. The condition arises due to caseous degeneration in the internal material of the mitral annulus calcification. On echocardiography, the calcification is a round mass with a central echolucent area, typically located at the base of the posterior leaflet, and can be mistaken for cardiac tumors or abscesses. We describe 3 patients with the condition, one of whom required surgical removal of the mass to obtain a definitive diagnosis. Full English text available from: www.revespcardiol.org

Live/Real Time Three‐Dimensional Transesophageal Echocardiographic Findings in Caseous Mitral Annular Calcification

We describe a 77-year-old female with hypertrophic cardiomyopathy in whom live/real time three-dimensional transesophageal echocardiography (3DTEE) provided incremental value over two-dimensional transthoracic and transesophageal echocardiography (2DTTE, 2DTEE) and three-dimensional transthoracic echocardiography (3DTTE) in making a more comprehensive assessment and a more confident diagnosis of caseous mitral annular calcification. 3DTEE revealed a portion of the mass to consist of small, multiple, highly echogenic discrete band-like and punctate areas within a relatively much less echogenic stroma and surrounded by a well defined highly echogenic border. This appearance correlated with the pathological findings of calcific granules/strands located in a liquefied or semiliquefied interior providing a typical toothpaste like appearance. The highly echogenic outer border represented the residual outer portion or rim of the calcific mass which did not undergo liquefaction. These findings on 3DTEE which correlated with the toothpaste like appearance seen at surgery were not visualized on 2DTTE, 2DTEE, and 3DTTE.

Extensive myocardial and mitral annular calcification leading to mitral regurgitation and restrictive cardiomyopathy: An unusual case of caseous calcification of the mitral annulus

A 62-year-old man with polymyalgia rheumatica and chronic atrial fibrillation with prior atrioventricular node ablation and pacemaker implantation presented with progressive exertional dyspnea. Transthoracic echocardiography showed restrictive filling as well as extensive calcification of the mitral annulus and severe mitral regurgitation from a restricted posterior leaflet. A round, hyperechoic lesion with central lucency was noted within the interventricular septum along with calcification of the basal anterior, lateral, and posterior segments of the left ventricle (Fig. 1; Supplementary Videos 1–2) unchanged since previous echocardiogram 2 years before. An electrocardiographic-gated dual-source cardiac CT (Somatom Definition Siemens Medical Solutions, Forchheim, Germany) confirmed extensive mitral annular calcification and diffuse, near-transmural involvement of a heterogenous peripherally calcified lesion (at largest 5.3×3.3 cm) within the myocardium (Fig. 2). This was more extensive than noted by echocardiography. These findings are consistent with an atypical caseous mitral annular calcification extending along the fibrous skeleton of the heart. Surgical repair was offered, but the patient elected for conservative management. Figure 2Cardiac CT images in short axis further delineating areas of diffuse involvement within the left ventricular myocardium. View Large Image Figure Viewer Download Hi-res image

Two Cases of Caseous Calcification of the Mitral Annulus

Caseous mitral annular calcification describes a heavy calcification of the mitral annulus with central liquefaction. This rare variant of mitral annular calcification may resemble an intracardiac tumor, abscess, vegetation, or thrombus, a resemblance that often leads to unnecessary surgery. Typical echocardiographic findings include a large, round, bright echogenic mass with a central echolucent area. It is known to have a benign clinical outcome, and it is thus managed conservatively. Because this entity is not well known and has only rarely been described, we report two cases of mitral annular calcification encountered at our institution. The first patient was an elderly woman with exertional dyspnea who was found to have a solitary pulmonary nodule on plain chest radiography. This was determined to represent caseous calcification of the mitral annulus. The other patient was an elderly woman who had a history of cerebral embolic infarction. She did not have an intracardiac thrombus, but she did have caseous mitral annular calcification. Both patients were managed conservatively. (Korean Circ J 2009;39:82-85)

Cardiac imaging in the evaluation of mitral annulus caseous calcification

The current case report illustrates a comprehensive assessment with different imaging techniques, as echocardiography, magnetic resonance and computer tomography, of a rare cardiac mass known as caseous calcification of mitral annulus. Transesophageal echocardiography was able to identify and characterize the caseous calcification of mitral annulus.

Caseous Calcification of the Mitral Valve Ring

Mitral annular calcification (MAC) is found in 10% of patients older than 50 years of age, and represents deposition of calcium between the basal infero-lateral ventricular wall and the posterior leaflet of the mitral valve. Caseous calcification, formed from a mixture of calcium, cholesterol and fatty acids, is an uncommon variant found on echocardiography in 0.6% of patients with MAC. The characteristic echographic appearance is of a large echo-dense structure with echo-lucent center and smooth borders. Caseous MAC carries a benign prognosis despite its impressive appearance and should not be misdiagnosed as a more serious condition such as myocardial abscess or tumor.

Surgical treatment of caseous mitral valve annulus calcification

Mitral annular calcification (MAC) is common in the elderly population. It can cause mitral regurgitation, mitral stenosis, and heart block and can complicate attempts to repair or replace the mitral valve. Extensive MAC can undergo liquefaction and simulate an intracardiac mass. Previously this rare entity was believed to be a benign incidental finding on imaging. We describe a case of caseous MAC mimicking a cardiac tumor and causing spontaneous cerebral embolization.