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Published on: May 31, 2016
Development of caseous calcification of mitral annulus after initiation of hemodialysis therapy
Hiroki Usuku1,2, Eiichiro Yamamoto2, Fumi Oike2
1Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
Insights
Caseous calcification of mitral annulus (CCMA) is linked to end-stage renal disease. This case highlights CCMA development after switching to hemodialysis, emphasizing echocardiography
Area of Science:
- Cardiology
- Nephrology
- Pathology
Background:
- End-stage renal disease (ESRD) often necessitates renal replacement therapy, including peritoneal dialysis (PD) and hemodialysis (HD).
- Mitral annular calcification is a known complication in patients with chronic kidney disease.
- Caseous calcification of mitral annulus (CCMA) is a rare form of mitral annular calcification.
Observation:
- A 59-year-old man with a history of 7 years of PD followed by 6 years of HD presented with a growing mass on the posterior mitral leaflet.
- Transthoracic echocardiography revealed a 15 mm echoic mass, which enlarged to over 25 mm within 6 years of commencing HD.
- Surgical intervention included tumor resection and mitral valve replacement.
Findings:
- Histological examination of the resected mass showed multiple calcified nodules and granulation tissue.
- The mass exuded a white, opalescent liquid upon incision.
- The findings confirmed the diagnosis of caseous calcification of the mitral annulus (CCMA).
Implications:
- This case suggests that CCMA can develop or progress significantly after the initiation of hemodialysis in patients with ESRD.
- Routine echocardiography is crucial for the early detection of CCMA, particularly in patients transitioning between PD and HD.
- Understanding the progression of CCMA in ESRD patients is vital for timely intervention and management.
Abstract:
We here present a 59-year-old man who had undergone peritoneal dialysis (PD) for 7 years and hemodialysis for the following 6 years in the Japanese Red Cross Kumamoto Hospital. Six years after commencing PD, transthoracic echocardiography showed a highly echoic mass with a transverse diameter of almost 15 mm in the posterior mitral leaflet. Because the mass increased from 2 years after initiation of hemodialysis, reaching over 25 mm by 6 years after commencing hemodialysis, tumor resection and mitral valve replacement were performed. When the surface of the mass was incised, white opalescent liquid drained out of the mass and histological examination showed multiple calcified nodules and granulation tissue, resulting in diagnosis of a caseous calcification of mitral annulus. <Learning Objective: Caseous calcification of mitral annulus (CCMA) is usually associated with end-stage renal disease. In the present case, a 59-year-old man had undergone peritoneal dialysis for 7 years, after which he had undergone hemodialysis for 6 years. The development of CCMA was seen after initiation of hemodialysis therapy. Routine echocardiography is useful for early diagnosis of CCMA, especially in patients whose type of dialysis changed from PD to hemodialysis.>.
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