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A case of caseous calcification of the mitral annulus: A potential source of embolic stroke

Haruhiko Higashi1, Takahiro Ohara1, Satoshi Nakatani2

  • 1Division of Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.

Journal of Cardiology Cases
|December 12, 2018
PubMed

Insights

Caseous calcification of the mitral annulus (CCMA), a rare MAC variant, may cause embolic strokes. This report suggests CCMA is a potential source for cerebral embolism, challenging previous views of its benign nature.

Area of Science:

  • Cardiology
  • Neurology
  • Radiology

Background:

  • Mitral annular calcification (MAC) is common in the elderly.
  • Caseous calcification of the mitral annulus (CCMA) is a rare MAC variant.
  • CCMA can be mistaken for cardiac tumors or abscesses.

Purpose of the Study:

  • To investigate the clinical significance of CCMA.
  • To determine if CCMA is a potential source of cerebral embolism.

Main Methods:

  • Echocardiography was used to identify CCMA in a patient with acute ischemic stroke.
  • Clinical presentation and imaging findings were analyzed.
  • Patient management and follow-up were documented.

Main Results:

  • A 76-year-old woman presented with ischemic stroke and was diagnosed with CCMA.
  • The patient experienced a second embolic stroke, with CCMA's central cavity appearing to communicate with the left atrium.
  • Anticoagulation therapy prevented further embolic events.

Conclusions:

  • CCMA may be an embolic source, contrary to previous reports suggesting it is benign.
  • This case highlights the potential embolic risk associated with CCMA.
  • Further research is needed to understand the clinical significance and management of CCMA.
Keywords:
Embolic strokeMitral annular calcificationTransthoracic echocardiography

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