The Spectrum of Caseous Mitral Annulus Calcifications

Abstract

Mitral annular calcification (MAC) is a chronic, degenerative condition of the fibrous mitral annulus, which may transform to liquefaction necrosis MAC, a rare variant of caseous MAC. We present a series of experiences, showing the varying manifestations of caseous MAC according to multimodal imaging. ( Level of Difficulty: Intermediate. )

A Caseating Tricuspid Mass in an Adult With Eisenmenger Syndrome Secondary to Aorto-Pulmonary Window

“…The peripheral calcific rim evident on echocardiography can be confirmed on CT imaging to encircle the valve annulus, with avascularity and lack of enhancement as key distinguishing features. 5 …”

Asymptomatic Caseous Calcification of the Mitral Annulus in a 66-Year-Old Woman with 3-Year Imaging Follow-Up

“…Mayr et al described a case of the detection of CCMA with CT scanning in a patient with previous biological aortic valve replacement and bypass surgery with long-term CT imaging surveillance. The imaging observation lasted for 19 years and revealed dynamic evolution of CCMA with an increase and decrease in the size of the lesion [ 25 ]. Abuarqoub et al described a case of asymptomatic CCMA lesion with a sustained size during a 2-year observation period.…”

Thrombotic ST-segment elevation myocardial infarction caused by a caseous mitral annular calcification

“…Histopathologically, CMAC is characterized by a liquefaction necrosis of the central region with amorphous eosinophilic acellular material, that is surrounded by macrophages and lymphocytes and bordered by multiple calcifications [4]. Although secondary consequences such as mitral valve regurgitation or stenosis caused by CMAC have been reported, a conservative approach is generally recommended due to the general benign prognosis [5][6][7]. However, patients with CMAC are at increased risk of arterial thromboembolism, especially embolic strokes, that are not related to atrial fibrillation [8].…”