A case report of left ventricular outflow tract obstruction due to early growth of a calcified amorphous tumour despite normal renal function

Figures

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  Figure 1. Transthoracic echocardiogram. A calcified tumour detected at the anterior mitral leaflet and left ventricular outflow tract obstruction in the apical three-chamber view.

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  Figure 2. Cardiac computed tomography displays a calcified mass. The mass seems to extend to the posterior of the left atrium and non-coronary cusp.

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  Figure 3. In pressure measurement with a catheter, the mean pressure gradient of the left ventricular outflow tract with valsalva provocation is 31 mmHg, and the maximum pressure gradient is 51 mmHg. We tested nitrogen provocation using nitro-glycerine (100 µg), displaying 75 mmHg in the maximum pressure gradient of the left ventricular outflow tract. When the Brockenbrough phenomenon was observed during catheter examination, the maximum pressure gradient of the left ventricular outflow tract was rising to 145 mmHg.

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  Figure 4. (A) Illustration of incisional view. The transseptal atriotomy and aortotomy were performed to across the left and non-coronary commissure into the anterior mitral valve leaflet with opening the IVF. (B) The gross findings of aortic valve cusps during surgery display a calcified amorphous tumour and septal myocardium protruding into the left ventricular outflow tract. RCS, right coronary sinus; VS, ventricular septum; NCS, non-coronary sinus; MS, membranous septum; CAT, calcified amorphous tumour; LA, left atrium; MV, mitral valve; PML, post-mitral leaflet; Ao, aorta, (C) CAT specimen after resection. CAT was covered with fibrous tissue. (D) Histopathology image of CAT. Most of the unstructured deposits are calcification. Calcium deposits are present in the cavity along with eosinophilic deposits. Macrophage infiltration was observed in the background.

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  Figure 5. Transthoracic echocardiogram. Preoperatively, the maximum pressure gradient in the left ventricular outflow tract was 85 mmHg with the valsalva manoeuvre, but it improved to 15 mmHg post-operatively.