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Caseous calcification of the mitral annulus presenting as recurrent strokes
Maria-Erato Zymatoura1, Panagiota Georgiadou1, Kalliopi Perlepe1
1Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
Insights
Caseous calcification of the mitral annulus, a rare condition, can lead to stroke. This report details a case where it caused recurrent strokes, highlighting the importance of medical management for stroke prevention.
Area of Science:
- Cardiology
- Neurology
Background:
- Caseous calcification of the mitral annulus (CCMA) is a rare entity, often incidentally discovered.
- It carries a significant risk of embolic complications, particularly stroke.
Observation:
- A 64-year-old female presented with recurrent ischemic strokes.
- Cerebral MRI revealed a right middle cerebral artery thrombus.
- Echocardiography identified mitral annular calcification with a mobile, echo-dense mass.
Findings:
- The patient's stroke episodes were attributed to CCMA with an associated thrombus.
- Medical management, including anticoagulation, was initiated.
- No further embolic events were observed during follow-up.
Implications:
- CCMA should be considered in patients with cryptogenic stroke, especially those with mitral annular calcification.
- Early diagnosis and appropriate medical management, including anticoagulation, are crucial for preventing recurrent embolic events.
- This case underscores the link between CCMA and cerebrovascular complications.
Abstract:
Although caseous calcification of the mitral annulus is usually diagnosed incidentally, it can cause embolic complications. The current report describes the case of caseous calcification revealed by recurrent episodes of stroke in a 64-year-old female patient. After her last ischemic episode, cerebral magnetic resonance imaging confirmed the presence of a thrombus in the right middle cerebral artery. Transthoracic echocardiogram revealed calcification of the mitral annulus and an echo-dense mass with mobile borders fixed posteriorly. Transesophageal echocardiogram allowed better evaluation of the lesion. A medical approach was preferred, with no recurrence thereafter.
Learning Objective:
Caseous calcification of the mitral annulus is a rare form of mitral annular calcification which is associated with high risk of strokes.Medical management with optimal anticoagulation can be effective over long-term follow up.
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