The Spectrum of Caseous Mitral Annulus Calcifications.
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ABSTRACT:
SUBMITTER: Mayr A
PROVIDER: S-EPMC8305068 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Mitral annular calcification (MAC) is considered a chronic and degenerative process involving the fibrous annulus of the mitral valve. The prevalence of MAC has been reported between 8% and 15%. It significantly increases with age, often seen in females, individuals with hypertension, chronic kidney disease and those with multiple cardiovascular risk factors. Caseous calcification of the mitral annulus (CCMA) (also known as caseoma) is a rare variant of MAC and should be considered in the differential diagnosis with other cardiac masses of the mitral valve. An 85-year-old female presented for a transthoracic echocardiogram with a history of hypertension and a systolic murmur. The echocardiogram demonstrated a possible rare variant of MAC, with independent mobile echodensities identified. Further testing using transoesophageal echocardiography was used to confirm diagnosis and ensure appropriate clinical management was arranged. This case demonstrated CCMA, a benign condition that can be mistaken for cardiac tumours, thrombus, vegetations or abscesses. A low prevalence has been reported between 0.06% and 0.07% and 0.6% of patients with MAC using echocardiography. Echocardiography can provide the initial diagnosis for identification and characterisation of MAC. CCMA appears as a calcified mass with an echolucent, liquid-like inner part, located on the posterior mitral valve annulus. Acoustic shadowing is usually absent. Multi-modality imaging can lead to an accurate diagnosis of CCMA without unnecessary interventions. Transoesophageal echocardiography provides further information on the site and composition of the internal material. Computed tomography (CT) and cardiac magnetic resonance imaging (MRI) can also be used, to confirm the diagnosis and to exclude other differential diagnoses.
| S-EPMC8412006 | biostudies-literature
Project description:BackgroundCaseous calcification of the mitral annulus (CCMA) is a very rare variant of mitral annular calcification, which is typically asymptomatic but can manifest as a cardiac tumour, abscess, or in the form of mitral valve dysfunction.Case summaryWe present a patient who developed shortness of breath and was initially thought to have an intracardiac tumour, but ultimately was recognized as massive calcification of the mitral valve by computed tomography angiogram. This finding was unfortunately made only shortly before the patient's clinical deterioration, and the specific diagnosis of CCMA was made on post-mortem findings, precluding any directed treatment for this entity.DiscussionCaseous calcification of the mitral annulus can lead to significant pathology, including mitral regurgitation, stenosis, or systemic embolization of caseous material. Due to its relative scarcity and tendency to be asymptomatic, a diagnosis of CCMA is often difficult to make or easily overlooked. Early recognition and appropriate treatment is crucial for avoiding these potential complications.
| S-EPMC6426072 | biostudies-literature
Project description:Highlights•Mitral annular calcification (MAC) is a common echocardiographic finding, estimated at around 14%, and occurs especially in elderly women.•Caseous calcification of the mitral annulus (CCMA) is a rare subvariant of MAC, with an echocardiographic prevalence of 0.6% and necropsy prevalence of about 2.3%.•CCMA, just like MAC, is believed to be associated with a high calcium score, coronary artery disease, aortic valve disease, atrial fibrillation, and hypertension.•CCMA can be confused echocardiographically with infective endocarditis, tumors, and cysts.•The decision for surgical treatment of CCMA is based on clinical judgment with factors such as valvular dysfunction and/or the propensity for stroke.
| S-EPMC6034490 | biostudies-other
Project description:BackgroundDrug-induced valvular heart disease (DI-VHD) is a well-defined condition associated with specific pathology features. However, clinical presentations may broadly vary and thereby make DI-VHD diagnosis more challenging.Case summaryWe report two patients with a history of benfluorex administration, who developed extensive mitral calcific lesions which evolved towards caseous necrosis.DiscussionProspective follow-up over several years of these two patients who initially had typical DI-VHD findings provided monitoring evidence of extensive calcifications and subsequent caseous necrosis. These reports suggest a link between calcific heart injury and benfluorex exposure. The diagnosis of DI-VHD may be overlooked at this late stage.
| S-EPMC8727063 | biostudies-literature
Project description: Not available
| S-EPMC8299984 | biostudies-literature
Project description:The shape of the mitral valve annulus is used in diagnostic and modeling applications, yet methods to accurately and reproducibly delineate the annulus are limited. This paper presents a mitral annulus segmentation algorithm designed for closed mitral valves which locates the annulus in three-dimensional ultrasound using only a single user-specified point near the center of the valve. The algorithm first constructs a surface at the location of the thin leaflets, and then locates the annulus by finding where the thin leaflet tissue meets the thicker heart wall. The algorithm iterates until convergence metrics are satisfied, resulting in an operator-independent mitral annulus segmentation. The accuracy of the algorithm was assessed from both a diagnostic and surgical standpoint by comparing the algorithm's results to delineations made by a group of experts on clinical ultrasound images of the mitral valve, and to delineations made by an expert with a surgical view of the mitral annulus on excised porcine hearts using an electromagnetically tracked pointer. In the former study, the algorithm was statistically indistinguishable from the best performing expert (p=0.85) and had an average RMS difference of 1.81+/-0.78 mm to the expert average. In the latter, the average RMS difference between the algorithm's annulus and the electromagnetically tracked points across six hearts was 1.19+/-0.17 mm .
| S-EPMC3122108 | biostudies-literature
Project description:ObjectivesThe purpose of this study was to evaluate tip-to-base intentional laceration of the anterior mitral leaflet to prevent left ventricular outflow tract obstruction (LAMPOON) in patients undergoing transcatheter mitral valve replacement (TMVR) in annuloplasty rings or surgical mitral valves.BackgroundLAMPOON is an effective adjunct to TMVR that prevents left ventricular outflow tract obstruction (LVOTO). Laceration is typically performed from the base to the tip of the anterior mitral leaflet. A modified laceration technique from leaflet tip to base may be effective in patients with a prosthesis that protects the aortomitral curtain.MethodsThis is a multicenter, 21-patient, consecutive retrospective observational cohort. Patients underwent tip-to-base LAMPOON to prevent LVOTO and leaflet overhang, or therapeutically to lacerate a long anterior mitral leaflet risking or causing LVOTO. Outcomes were compared with findings from patients in the LAMPOON investigational device exemption trial with a prior mitral annuloplasty.ResultsTwenty-one patients with a annuloplasty or valve prosthesis-protected mitral annulus underwent tip-to-base LAMPOON (19 preventive, 2 rescue). Leaflet laceration was successful in all and successfully prevented or treated LVOTO in all patients. No patients had significant LVOTO upon discharge. There were 2 cases of unintentional aortic valve injury (1 patient underwent emergency transcatheter aortic valve replacement and 1 patient underwent urgent surgical aortic valve replacement). In both cases, the patients had a supra-annular ring annuloplasty, and the retrograde aortic guiding catheter failed to insulate the guidewire lacerating surface from the aortic root. All patients survived to 30 days. Compared with classic retrograde LAMPOON, there was a trend toward shorter procedure time.ConclusionsTip-to-base laceration is a simple, effective, and safe LAMPOON variant applicable to patients with an appropriately positioned mitral annular ring or bioprosthetic valve. Operators should take care to insulate the lacerating surface from adjacent structures.
| S-EPMC8080374 | biostudies-literature
Project description: Not available
| S-EPMC10439705 | biostudies-literature
Project description:BACKGROUND:Mitral annulus calcification (MAC) is an important echocardiographic finding that is significantly associated with valvular abnormalities. However, the effect of documented MAC on all-cause mortality is not known. Using a large database, associations between MAC and long-term all-cause mortality were evaluated. METHODS:A retrospective analysis of 3169 echocardiograms, which were performed for clinical reasons in southern California between 1983 and 1998 in patients between 16 and 99 years of age, was performed. Mortality data were extracted from the national mortality database at the end of 2007. Using uni- and multivariate analysis, associations between total mortality and the echocardiographic presence of MAC documented in the final report by the interpreting cardiologist were evaluated. RESULTS:MAC was significantly associated with all-cause mortality (174 of 334 [52.1%] patients with MAC died versus 709 of 2835 [25.0%] patients without MAC; OR 3.26 [95% CI 2.58 to 4.10]; P<0.001). Using multivariate analysis adjusting for age, left ventricular hypertrophy, sex, abnormal left ventricular systolic function and significant valvular abnormalities, MAC remained independently associated with all-cause mortality (OR 2.50 [95% CI 1.81 to 3.45]; P<0.001). CONCLUSION:Using a large echocardiographic database, MAC was found to be independently associated with all-cause mortality. This finding confirms the importance of an abnormal mitral annulus as an important prognostic marker.
| S-EPMC3716491 | biostudies-literature
Project description: Not available
| S-EPMC8015991 | biostudies-literature