Caseous calcification of the mitral annulus with mitral regurgitation and impairment of functional capacity: a case report

Abstract

IntroductionMitral annular calcification is a common echocardiographic finding, especially in the elderly. Caseous calcification of the mitral annulus, however, is a relatively rare variant, having an echocardiographic prevalence of 0.6% in patients with mitral annular calcification. Caseous calcification needs to be differentiated from infected mitral annular calcification, mitral annular abscess and tumours. It is not malignant, and medical therapy with clinical follow-up is the therapeutic option. Surgery should be reserved for co-existent mitral valve dysfunction.Case presentationWe report the case of a 69-year-old woman, in whom caseous calcification of the mitral annulus was found at transthoracic echocardiography. Cardiac surgery was performed because of significant mitral regurgitation and impairment of functional capacity.ConclusionCaseous calcification of the mitral annulus needs to be considered and confirmed by transthoracic echocardiography since there is potential for diagnostic confusion or misdiagnosis. This lesion appears to have a benign prognosis but, when associated with mitral valve dysfunction, cardiac surgery appears to be the best therapeutic option.

Severe Mitral Regurgitation and Heart Failure due to Caseous Calcification of the Mitral Annulus

“…It may be true in most cases, but in our case, the secondary severe mitral regurgitation, the HF and the AF would have made the prognosis poor without surgical intervention. There are only 5 cases reported in the literature where heart surgery was performed due to CCMA-induced severe mitral regurgitation and HF [5,6]. There are data that CCMA may have a regressive or progressive nature [1,10], but in the literature, we have found no data of such a rapid progression and deterioration in the clinical course, as it happened in our case.…”

“…It should be differentiated from an abscess, tumor and thrombus. In a few cases, severe mitral regurgitation was reported as a complication of CCMA [5,6,7,8,9]. …”

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

“…2,3 Echocardiography typically identifies this entity as a round, calcified, echogenic mass. 4 CMR reveals a mass between the posterior mitral annulus and adjacent myocardium, with no enhancement after contrast administration and with strong peripheral enhancement 10 minutes after gadolinium administration with the use of the contrast-enhanced inversion-recovery technique. 5 CT confirms the calcified aspect of the mass.…”

“…Histological examination of the inner fluid usually reveals an amorphous, basophilic content, composed of a putty-like admixture of fatty acids, cholesterol, calcium and inflammatory cells, mainly macrophages. 4,6 Early recognition of this entity avoids an invasive diagnostic approach, since it is benign and, unlike intracardiac tumors and abscesses, has a favorable prognosis. 7 Surgery should be reserved for cases with severe co-existent mitral valve dysfunction, originating from compromised mitral leaflet coaptation secondary to mitral annulus distortion due to CCMA.…”

Cardiac mass in a patient with colorectal cancer: “Not all that glitters is gold!”

“…This condition carries a benign prognosis. Surgery may be rarely needed due to hemodynamic compromise [4,5] . The association of colorectal cancer (CC) with CCMA has not been described previously.…”