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A Case of Transient Hypercalcemia Following Fistulization of a Calcified Mitral Annulus

Kobi Jacob Perl1, Michal Julius1, Dror Cantrell1

  • 1Department "C" of Internal Medicine, Shamir Medical Center, Sackler Medical School Tel Aviv University, Tzrifin 70300, Israel.

JCEM Case Reports
|January 5, 2024
PubMed

Insights

A calcified mitral annulus (CMAC) fistulization caused severe hypercalcemia and embolic strokes. This rare cardiac event highlights CMAC risks and a unique cause of transient hypercalcemia.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Pathology

Background:

  • Severe symptomatic hypercalcemia can present with diverse etiologies.
  • Calcified mitral annulus (CMAC) is a degenerative cardiac condition.
  • The association between CMAC and systemic complications is not well-established.

Observation:

  • A patient presented with severe hypercalcemia, successfully treated with fluids and furosemide.
  • The patient later returned with multiple embolic strokes of unknown origin.
  • Cardiac imaging revealed a disappearing calcified mitral annulus (CMAC) cavity, suggesting fistulization into the left ventricle.

Findings:

  • The fistulization of the CMAC likely released caseous material into the bloodstream, causing transient hypercalcemia.
  • The same event is proposed as the source of the embolic strokes.
  • This case demonstrates a direct link between CMAC fistulization and both hypercalcemia and embolic events.

Implications:

  • This case highlights a rare but serious mechanism for transient hypercalcemia.
  • It underscores the potential embolic risks associated with calcified mitral annulus pathology.
  • Early recognition of CMAC fistulization may prevent severe systemic complications.

Keywords:
caseous mitral annular calcification (CMAC)hypercalcemiahyperphosphatemialiquefaction necrosismitral annulus calcification (MAC)

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