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Coronary artery erosion and dissection: an unusual complication of mitral annular calcification
1Department of Laboratory Medicine, Ottawa Hospital--Civic Site, Ontario, Canada.
Abstract:
This article describes a 42-year-old male patient with a longstanding history of insulin-dependent diabetes mellitus, systemic arterial hypertension, and chronic renal failure. The patient had severe mitral annular calcification (MAC) identified at autopsy. This MAC was of an amorphous, caseous-appearing type; it displaced the posterior mitral valve leaflet and extruded into the myocardium of the lateral and posterolateral left ventricle to involve the epicardial surface. The MAC produced extramural erosion of the wall, and dissection into the media, of the first left/obtuse marginal coronary artery. This coronary artery involvement by, and other complications of, MAC are discussed.
Insights
Severe mitral annular calcification (MAC) in a diabetic patient caused significant cardiac and coronary artery damage. This autopsy case highlights the extensive complications of amorphous, caseous-appearing MAC.
Area of Science:
- Cardiovascular Pathology
- Diabetology
- Nephrology
Background:
- The case involves a 42-year-old male with a history of insulin-dependent diabetes mellitus, systemic arterial hypertension, and chronic renal failure.
- These comorbidities often predispose patients to cardiovascular complications.
Observation:
- Autopsy revealed severe mitral annular calcification (MAC) with an unusual amorphous, caseous-appearing morphology.
- The MAC significantly displaced the posterior mitral valve leaflet and extended into the left ventricular myocardium and epicardium.
Findings:
- The mitral annular calcification caused extramural erosion and dissection into the media of the first left/obtuse marginal coronary artery.
- This demonstrates direct coronary artery involvement as a complication of severe MAC.
Implications:
- Severe MAC can have extensive and destructive effects beyond the valve annulus, including coronary artery pathology.
- This case underscores the importance of considering MAC as a potential cause of cardiac and coronary complications in patients with diabetes and renal failure.