No abstract

C alcific deposits in the epicardial arteries, mitral valve annulus, and aortic valve cusps are common in older persons in the Western world. 1 Recently, we encountered a patient with massive mitral annular calcium causing mitral stenosis in association with a stenotic congenitally bicuspid aortic valve and heavy coronary calcific deposits. The extent of the cardiac calcific deposits is unusual and prompted this report.A 73-year-old man had an orthotopic liver transplant for alcoholic cirrhosis at age 60, a renal transplant at age 65, a dual-chamber pacemaker inserted for sick sinus syndrome at age 72, and had corticosteroid-induced diabetes mellitus and systemic hypertension. The present examination was prompted by the recent onset of pedal edema. A grade 2/6 systolic ejection murmur that was loudest over the right base of the precordium was present. His body mass index was 22 kg/m 2 . Echocardiography disclosed a 6-mm Hg mean diastolic gradient at the mitral orifice and a left ventricular ejection fraction of about 55% ( Figure 1). Cardiac catheterization revealed a peak systolic pressure gradient between the left ventricle and aorta of 50 mm Hg (mean gradient, 38 mm Hg) and an aortic valve area of 0.6 cm 2 . The left anterior descending artery was narrowed up to 70% in diameter proximally, the second diagonal artery up to 80% proximally, and the ramus intermedius artery up to 80% proximally. The left main coronary artery was widely patent. The dominant left circumflex artery was narrowed up to 50% in diameter and was heavily calcified. The nondominant right coronary artery was free of narrowing.The aortic valve was replaced with a 21-mm Medtronic Mosaic (Medtronic, Inc., Mineapolis, MN) bioprosthesis. The surgically removed aortic valve was congenitally bicuspid (Figure 2). Aortosaphenous vein grafts were placed to the left anterior descending and the first marginal coronary arteries. An intra-aortic balloon pump was placed intraoperatively. Aortic cross-clamp time was 149 minutes. The postoperative course was complicated by the low cardiac output syndrome, and death occurred 5 days postoperatively.At necropsy, the coronary arteries and mitral annular region were massively calcified (Figure 3). The ventricular cavities were not dilated ( Figure 4). The bioprosthesis in the aortic valve position appeared to have functioned normally. The venous conduits to the left anterior descending and obtuse marginal arteries were patent.The most prevalent site of cardiac calcific deposits is the epicardial coronary arteries, followed by the mitral annular area and aortic valve cusps. The apical portions of the left papillary

No abstract

No abstract

No abstract