Thrombus Associated With Mitral Valve Calcification

Stein, James H.; Soble, Jeffrey S.

doi:10.1161/01.str.26.9.1697

Cited by 41 publications

(22 citation statements)

References 17 publications

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“…MAC may act as a direct source of emboli or merely as a marker of conditions associated with thrombo-embolism, such as hypertension, general atherosclerosis, advanced age, congestive heart failure, atrial fibrillation and diabetes [1-3, [16][17][18][19][20][21]. Case reports and epidemiological studies suggest a strong relation between MAC and stroke [3, [22][23][24][25][26][27][28].…”

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confidence: 99%

Mitral annulus calcification is not an independent risk factor for stroke: a cohort study of 657 patients

et al. 1997

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All studies but one in the past have shown a strong relative risk of mitral annulus calcification for stroke, but the contribution of associated cardiac and vascular risk factors, especially carotid atheroma has not been appreciated. We studied the risk of stroke in selected patients with mitral annular calcification, adjusting for clinical, echocardiographic and therapeutic factors influencing stroke risk. Of 8,160 consecutive patients with echocardiograms, 657 with and 562 without mitral annulus calcification were followed for a mean of 2.4 years (range 1-6.6) to determine stroke risk by means of proportional hazards models with clinical, echocardiographic, and therapeutic variables that influence the risk of stroke. We also determined the association of mitral annulus calcification with subtypes of ischaemic brain lesions generally considered to be specific for an underlying cardioembolic cause. We therefore distinguished between territorial, small deep, and asymptomatic (silent) brain infarcts. Fifty-one patients with mitral annulus calcification and 27 controls had a stroke in the follow-up period. Mitral annulus calcification was not significantly associated with stroke in proportional hazards models (hazard ratio 0.76, 95% confidence interval 0.42-1.36, P = 0.3), or with any of the stroke subtypes, or with the presence of silent brain infarcts after adjustments for risk factors for generalized vascular disease Hypertension and carotid atheroma, with or without stenosis, ipsilateral or contralateral to the side of the stroke, were significantly associated with stroke in our patients. This study does not support the view that mitral annulus calcification is a risk factor for stroke. As others have found strong associations between mitral annulus calcification and cardiac and vascular risk factors for stroke, the increased risk of stroke in patients with mitral annulus calcification reported may be explained by these confounding risk factors. Therefore, in our opinion, mitral annulus calcification requires treatment of cardiovascular risk factors, but generally no specific measures such as surgery or oral anticoagulants are required to lower the risk of stroke.

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confidence: 99%

Mitral annulus calcification is not an independent risk factor for stroke: a cohort study of 657 patients

et al. 1997

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“…Moreover it can mimick tumors, vegetations or thrombi. Our primary concern about following the patient conservatively was increased risk of stroke [8]. Harpaz et al [9] followed 13 patients with mitral annular calcification and caseous necrosis conservatively over 3.8 years and stroke occured in none of the patients.…”

Section: Discussionmentioning

confidence: 99%

A case of mobile mitral annular mass

Elalmış¹,

Karagöz²,

Şahin³

et al. 2013

CMJ

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Mitral annular calcification is a chronic, degenerative process of the mitral valve fibrous ring, primarily involving the posterior annulus. This report presented a case of mitral annular calcification with mobile components which was found incidentally during TTE. The echocardiographic differential diagnosis of a mass includes thrombus, vegetation, primary or secondary cardiac tumor and extensive mitral annular calcification with mobile components. A calcified, mobile mass attached to the posterior mitral annulus should raise the suspicion of extensive mitral annular calcification. Serial echocardiograms in our patient documented that these mobile elements can resolve rapidly. The optimal treatment or clinical approach to this clinical condition remains to be established.

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“…Several studies have demonstrated an association between stroke and mitral annular calcification (MAC), although a causal link has not been established. 10 The mechanism of stroke is thought to be embolic, and thrombus overlying MAC has been described, 10 but calcific embolism has also been suggested. 1 We presume thromboembolism was the mechanism of the transient ischaemic attack.…”

Section: Discussionmentioning

confidence: 99%

Multimodality imaging of exuberant mitral annular calcification in a patient presenting with transient ischaemic attack

Vijayan

Fielding²,

Kahan³

et al. 2011

J R Coll Physicians Edinb

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An 81-year-old woman presented to the emergency department with sudden onset weakness of the right side of the body, which had caused her to fall through a glass door and injure her arm. She also had expressive dysphasia. The patient had a previous medical history of hypertension, hypercholesterolaemia and spondylosis. More than a decade ago she had been labelled as suffering from 'angina', based on asymptomatic ST-segment depression during stage 2 of a Bruce protocol. There was no history of rheumatic fever.Her weakness and expressive dysphasia resolved completely in 90 minutes. On examination, the arterial pulse was regular and normal in character, blood pressure was 138/72 mmHg in the right arm and the heart rate was 80 bpm. The patient's electrocardiogram showed sinus rhythm with occasional ventricular ectopic beats. The first heart sound was loud and there was a pansystolic murmur grade 3/6 at the mitral area. Neurological examination performed by the admitting physician was normal. Figure 1 Zoomed, slightly off-axis apical four-chamber view, demonstrating a globular mass with a hypoechoic centre, in the lateral segment of the mitral annulus. Figure 2Transoesophageal echocardiographic appearances of the mass, in a four-chamber view. The relationship with the mitral valve is better appreciated than on the transthoracic scan. The mass is located on the ventricular aspect of the annulus and distorts the posterior mitral leaflet slightly.

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Thrombus Associated With Mitral Valve Calcification

Abstract: These cases support the hypothesis that thrombus formation may be a pathophysiological link between ischemic cerebral events and mitral annular calcification in some patients.

Cited by 41 publications

References 17 publications

Mitral annulus calcification is not an independent risk factor for stroke: a cohort study of 657 patients

Mitral annulus calcification is not an independent risk factor for stroke: a cohort study of 657 patients

A case of mobile mitral annular mass

Multimodality imaging of exuberant mitral annular calcification in a patient presenting with transient ischaemic attack

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