Key result
Massive caseous mitral annular calcification presents as symptomatic complete heart block diagnosed by fluoroscopy.
Case Report (n=1)
Caseous calcification of the mitral annulus can present with symptomatic complete heart block and may require multimodality imaging including fluoroscopy and CT for accurate diagnosis.
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Alerts clinicians to rare caseous MAC in unexplained heart block; single case leaves open systematic imaging evaluation.
Mitral Annular Calcification (MAC) could even be a chronic, degenerative process of the fibrous support structure of the mitral valve [1,2]. MAC is usually visualized on echocardiography as an echo-dense shelf-like structure with an irregular, lumpy appearance involving the mitral valve annulus, with associated acoustic shadowing. within the Cardiovascular Health Study [3], MAC was quantified as mild (focal, limited increase in echodensity of the mitral annulus), moderate (marked echodensity involving one third to a minimum of 1 half the ring circumference), or severe (marked echodensity involving quite half the ring, or with intrusion into the left ventricular [LV] inflow tract).
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Nikoo et al. (2022) conducted a case report in Caseous calcification of the mitral annulus with complete heart block (n=1). A 77-year-old man presented with symptomatic complete heart block due to massive caseous calcification of the mitral annulus, demonstrating the utility of fluoroscopy for diagnosis in complex cases.
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