Caseous Mitral Annular Calcification Along the Anterolateral Annulus Causing Mild Mitral Regurgitation

Lee, Christopher; Yoon, Andrew; Klipfel, Nancy; Cunningham, Mark J.; Saremi, Farhood

doi:10.1253/circj.cj-12-0582

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…The lesion is usually asymptomatic but may occasionally distort the mitral annulus, resulting in mitral regurgitation. CT reveals a dense mass without contrast enhancement, while MR imaging demonstrates a mass along the mitral annulus that appears hypointense with all sequences (51,52).…”

Section: Degeneration and Calcification Of Fibrous Skeletonmentioning

confidence: 99%

Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging

et al. 2017

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The fibrous skeleton is concentrated at the base of the ventricular mass. It provides electrical insulation at the atrioventricular level and fibrous continuity for the leaflets of the mitral, aortic, and tricuspid valves. Its components include the fibrous trigones, the fibrous area of aortic-mitral continuity, the subvalvar collar of the mitral valve, the membranous septum, the interleaflet triangles, the tendon of Todaro, and likely the conus ligament. The majority of the mitral annulus is fibrous, but the only true fibrous part of the tricuspid annulus is where the valvar leaflets are attached to the central fibrous body. At the aortic annulus, the fibrous elements support only the noncoronary aortic sinus and parts of the right and left coronary sinuses. The ring-shaped annulus of the arterioventricular valves as localized with imaging techniques (imaging annulus) differs from the crown-shaped hemodynamic annulus of the arterial valves. The imaging annulus corresponds to the plane passing through the nadirs of the hinge-lines of the leaflets. The hinges of the pulmonary valve are not part of the fibrous skeleton. Computed tomography (CT) and magnetic resonance (MR) imaging are excellent modalities for evaluation of the anatomy, physiologic variations, and pathologic conditions of the fibrous skeleton. The submillimeter isotropic three-dimensional datasets obtained with CT and the high contrast resolution of MR imaging are the main advantages of these modalities in assessing anatomy. The function of the valves and associated annuli can best be studied with MR imaging. Pathologic conditions involving the area, including paravalvar leaks, abscesses, perforation, and pseudoaneurysms, usually occur as a complication of infective endocarditis or extensive calcifications after valvar surgery. MR imaging and CT can demonstrate these lesions equally well. CT is the preferred technique for showing the extent of calcifications in the fibrous skeleton. Large calcifications involving the central fibrous body can cause heart block by interfering with the normal function of the His bundle and its branches. RSNA, 2017.

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Section: Degeneration and Calcification Of Fibrous Skeletonmentioning

confidence: 99%

Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging

et al. 2017

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“…In fact, most cases of CCMA are diagnosed as a part of the workup for an intracardiac mass. Multimodality imaging, including 3‐dimensional (3D) transesophageal echocardiography (TEE), cardiac magnetic resonance imaging (MRI), and computed tomography (CT) can be used in suspicious cases to avoid unnecessary surgery …”

Section: Imagingmentioning

confidence: 99%

Caseous Calcification of the Mitral Annulus: A Review

Elgendy

Conti

2013

Clinical Cardiology

102

132

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Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification (MAC). Since most cardiologists are unfamiliar with CCMA, it is commonly misdiagnosed as an abscess, tumor or infective vegetation on the mitral valve. In most cases, conservative management for this lesion is sufficient. In this review, we will discuss the various aspects of this condition and illustrate the gross and histologic pathology as well as various imaging modalities (Ultrasound, Computed tomography, Cardiac Magnetic resonance) to assess this unusual cardiac mass.

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“…However, this entity is diagnosed on cardiac MRI and multimodality imaging, especially non-contrast CT, allows for a confident, reliable diagnosis [11–17]. …”

Section: Discussionmentioning

confidence: 99%

Mitral annulus caseous calcification mimicking cardiac mass in asymptomatic patient – multimodality imaging approach to incidental echocardiographic finding

et al. 2014

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SummaryBackgroundCaseous calcification of mitral annulus is rather rare echocardiographic finding with prevalence of 0.6% in pts. with proven mitral annular calcification and 0.06% to 0.07% in large series of subjects in all ages. Echocardiographic images of caseous calcification are often heterogenous due to calcium and lipid deposits, and the masses show hyperechogenic and hypoechogenic areas. However the appearance of caseous calcification can imitate that of abscess, tumors and cysts, surgical treatment may not be needed when there is no obstruction.Case Report76-year old obese (BMI 32 kg/m2), female patient with history of hypertension, stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with no symptoms of mitral valve dysfunction and had no abnormalities on physical exam. Transesophageal echocardiography identified well-organized, composite, immobile lesion (22×15 mm) localized in the posterior part of the mitral annulus, with markedly calcified margins, and no significant impact on the valve function. In computed tomography (CT) lesion was described as calcified (24×22×17.5 mm), connected with posterior leaflet and posterior part of the mitral annulus, reducing posterior leaflet mobility. CT brought the suggestion of caseous mitral annular calcification. Coming to a conclusion, bearing in mind no mitral valve dysfunction at that time, patient was offered conservative treatment.ConclusionsAlthough caseous mitral annular calcification is typically an incidental finding, accurate recognition is needed to avoid mistaking the lesion for a tumor or abscess, which may result in unnecessary cardiac surgery. However this entity is diagnosed on cardiac MRI, multi-modality imaging, especially non-contrast CT, allows for the confident, prospective diagnosis.

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Caseous Mitral Annular Calcification Along the Anterolateral Annulus Causing Mild Mitral Regurgitation

Abstract: IMAGES IN CARDIOVASCULAR MEDICINE

Cited by 6 publications

References 8 publications

Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging

Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging

Caseous Calcification of the Mitral Annulus: A Review

Mitral annulus caseous calcification mimicking cardiac mass in asymptomatic patient – multimodality imaging approach to incidental echocardiographic finding

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