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Considerations in caseous calcification of the mitral annulus: a case report
Jwan A Naser1, Mohamad R Hemu1, Patricia A Pellikka1
1Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
European Heart Journal. Case Reports
|November 23, 2022
Summary
Caseous calcification of the mitral annulus, a rare condition, can lead to embolic strokes and infective endocarditis (IE). Early recognition and management are crucial for patient outcomes.
Area of Science:
- Cardiology
- Radiology
- Infectious Diseases
Background:
- Caseous calcification of the mitral annulus (CCMA) is an extremely rare variant of mitral annulus calcification, occurring in less than 1% of cases.
- Degeneration of caseous masses in CCMA can serve as a source for embolic strokes and a nidus for infective endocarditis (IE).
Observation:
- A man in his sixties presented with transient left arm weakness, history of bioprosthetic aortic valve replacement, and recent pneumococcal pneumonia with empyema and bacteremia.
- Imaging revealed multifocal embolic strokes, degenerative bioprosthetic aortic valve dysfunction, mitral annular calcification with mobile calcific masses, and persistent empyema.
- 18F-fluorodeoxyglucose-positron emission tomography-CT showed indeterminate activity on the posterior mitral leaflet.
Findings:
- The patient was treated conservatively with a 6-week course of antibiotics due to high surgical risk.
- Repeat echocardiography showed stable mitral masses, and at 4 months, there was no evidence of recurrent clinical strokes.
Implications:
- CCMA is a rare but increasingly recognized predisposing factor for embolic strokes and IE.
- While surgical resection of calcified masses is ideal, conservative management may be considered in high-risk patients.
- This case highlights the importance of considering CCMA in patients with embolic events and cardiac abnormalities.
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