Key result
Multimodality imaging confirms benign caseous mitral calcification, enabling safe conservative management.
Why the study?
Caseous calcification of the mitral annulus is a rare degenerative mitral valve disease that appears as a globular intracardiac mass and requires careful cardiovascular imaging for accurate diagnosis.
Case Report (n=1)
No
Complementary multimodality imaging combining echocardiography, CMR, and CT calcium scoring accurately differentiates benign caseous calcification of the mitral annulus from other intracardiac masses, avoiding unnecessary cardiac intervention prior to non-cardiac surgery.
Answers are grounded in this paper and cite their sources.
May rarely precipitate acute mitral regurgitation; leaves open optimal management strategies in symptomatic patients.
Introduction: Caseous calcification of the mitral annulus (CCMA) is a form of degenerative disease of mitral valve. Related to mitral annular calcification (MAC), CCMA is found in approximately 0.64% of patients with MAC, and about 0.06-0.07% of the general population. Located most commonly in the posterior mitral annulus, attached to ventricular surface of posterior leaflet and adjacent to basal posterior myocardial segment, it has an appearance of a globular intracardiac mass, and requires careful cardiovascular imaging. We present a case of CCMA incidentally found during routine echocardiography. Case and Initial Imaging Techniques: A 78-year-old woman was admitted to the surgical department for routine orthopaedic surgery. A preoperative echocardiogram was performed in the view of previous mild aortic stenosis. This revealed a hyperdense, well defined, round, smooth mass located in the posterior mitral valve annulus which was immobile relative to the mitral annulus (Fig.1). There was no impairment of mitral valvular function. The patient was referred for cardiovascular magnetic resonance (CMR) imaging which revealed a globular mass with smooth outline located subendocardially in the basal inferolateral region of left ventricle. The mass was hyperdense on both T1 and T2-weighted images, did not supress with fat saturation, did not enhance in early contrast acquisitions and late enhancement sequences revealed bright rim with centre remaining dark (Fig.2, A-E). The CMR images were suggestive of CCMA although neither echocardiography nor CMR evidence calcification well. Therefore to confirm the diagnosis, CT calcium scoring was performed, which revealed an area of severe calcification in lateral mitral annulus, supporting the diagnosis of CCMA (Fig. 2F). Do to the benign nature of CCMA this was managed conservatively and underwent successful elective surgery with an uncomplicated post-operative course.
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Lech et al. (2016) conducted a case report in Caseous calcification of the mitral annulus (CCMA) and mild aortic stenosis (n=1). Multimodality cardiovascular imaging (echocardiography, CMR, and CT calcium scoring) and conservative management was evaluated on Definitive diagnosis of caseous calcification of the mitral annulus and post-operative clinical course. Multimodality imaging with echocardiography, CMR, and CT calcium scoring confirmed benign caseous calcification of the mitral annulus in a 78-year-old woman, allowing conservative management.
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