Extensive Mitral Annular Calcification Research Articles

広範囲の弁輪部石灰化を伴った僧帽弁逆流に対しＣＵＳＡおよびＭＩＲＡ弁を用いて弁置換を行った１例

広範囲の弁輪部石灰化を伴った僧帽弁逆流に対しＣＵＳＡおよびＭＩＲＡ弁を用いて弁置換を行った１例

Accuracy and pitfalls of early diastolic motion of the mitral annulus for diagnosing constrictive pericarditis by tissue Doppler imaging

Mitral annular velocities are reportedly useful in diagnosing constrictive pericarditis (CP); however, their exact efficacy in larger clinical settings remains unevaluated. This study reexamined the role of longitudinal tissue Doppler imaging in diagnosing CP in clinical practice. Tissue velocity imaging (GE Vingmed System Five) was performed in 122 subjects (87 referred with clinically suspected CP and 35 age- and sex-matched controls). Of the 87 subjects with suspected CP, 45 (51.7%) had CP confirmed at surgery, 11 (12.6%) had restrictive heart disease, 20 (23.0%) had right heart failure due to cor pulmonale, and the other 11 (12.6%) had old pericardial effusions and no hemodynamic evidence of constriction on follow-up echocardiography. Of the 45 patients with CP, mitral early diastolic (Ea) annular velocities from septal and lateral regions were normal (≥8 cm/s) in 40 (88.9%) and decreased (<8 cm/s) in 1 or both regions in 5 (3 with left ventricular systolic dysfunction, 2 with extensive mitral annular calcification). Of 11 patients with restrictive cardiomyopathy, 8 (72.7%) had reduced Ea (<8 cm/s) and 3 showed normal Ea velocity in 1 or both corners of the mitral annulus. All except 2 patients with right-sided heart failure from cor pulmonale and those with previous pericardial effusion had normal Ea velocities. A normal Ea velocity improved recognition of CP, particularly in the presence of nondiagnostic 2-dimensional or transmitral flow-Doppler imaging. The overall sensitivity and specificity for diagnosing CP using tissue Doppler incrementally with M-mode, 2-dimensional, and transmitral flow Doppler were 88.8% and 94.8%, respectively. Mitral annular velocities help with diagnosis and differentiation of CP in most cases, except in the presence of extensive annular calcification, left ventricular systolic dysfunction, or segmental nonuniformity in myocardial velocities.

Mitral valve surgery in patients with extensive calcification of the mitral annulus

ObjectivesThe objective of this work was to examine the clinical outcomes of mitral valve surgery in patients with extensive mitral annular calcification. MethodsMitral valve surgery was performed in 54 patients (28 men and 26 women, mean age 63 ± 14 years) with mitral regurgitation and extensive mitral annular calcification. Most patients (78%) were in New York Heart Association classes III and IV, 14 had coronary artery disease, and 9 had prior mitral valve replacement in which the calcium bar was not removed. The calcium bar was excised and a new mitral annulus was created by suturing a strip of pericardium onto the endocardium of the left ventricle from lateral to medial fibrous trigones and to the endocardium of the left atrium. The mitral valve was repaired in 12 patients and replaced in 42. In 23 patients the intervalvular fibrous body was reconstructed and the aortic valve was also replaced. Mean follow-up was 4.1 ± 3.7 years and was complete. ResultsThere were 5 operative deaths and 11 late deaths. Five-year survival was 73 ± 7%. Four patients needed reoperation and each survived. Freedom from reoperation at 5 years was 89 ± 6%. Three patients had a stroke and 4 had anticoagulation-related hemorrhage, one of which was fatal. Five-year freedom from valve-related mortality or morbidity was 75 ± 8%. Most survivors were in New York Heart Association functional classes II and III. ConclusionsResection of the calcium bar and creation of a new annulus with pericardium provided good clinical results in patients with extensive calcification of the mitral valve.

Tumor‐Like Mitral Annular Calcification with Central Liquefaction

Calcification of the mitral annulus is a degenerative process, which occurs mainly in older patients. Rarely, an extensive mitral annular calcification (MAC) with central liquefaction was reported. We report the case of extension of MAC into the adjacent left ventricular posterior wall along with central liquefaction and posterior mitral leaflet displacement in a 63‐year‐old woman. The abnormal size of the MAC and unusual echo density of pasty material inside made a correct diagnosis difficult and intracardiac tumor was suspected. Thus, similar uncommon clinical presentation of MAC should be considered in the differential diagnosis of intracardiac masses.

Left Atrial Mass Produced by Extensive Mitral Annular Calcification

An unusual case of mitral annular calcification presenting as a left atrial mass is discussed. The differential diagnosis of left atrial masses with particular reference to their echocardiographic features is reviewed.