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Ruptured Caseous Calcification of the Mitral Annulus With Left Ventricular-Left Atrial Fistula Formation Causing

Ayano Kurihara1, Kenji Harada1, Sumika Wachi1

  • 1Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.

Echocardiography (Mount Kisco, N.Y.)
|August 22, 2025
PubMed

Insights

This case report details a rare complication of caseous calcification of the mitral annulus (CCMA). A rupture led to a left ventricular-to-left atrial fistula, causing hemolytic anemia.

Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Pathology

Background:

  • Caseous calcification of the mitral annulus (CCMA) is a rare degenerative condition.
  • Complications of CCMA are infrequent but can be severe.
  • Accurate diagnosis is crucial for appropriate management.

Observation:

  • A patient presented with symptoms suggestive of anemia.
  • Three-dimensional transesophageal echocardiography (3D-TEE) was utilized for detailed cardiac assessment.
  • The imaging revealed a fistula connecting the left ventricle to the left atrium.

Findings:

  • The fistula was identified as a direct consequence of CCMA rupture.
  • The rupture and subsequent fistula caused significant hemolysis.
  • Hemolytic anemia was confirmed as the clinical outcome.

Implications:

  • This case underscores the potential for CCMA rupture to cause significant cardiovascular complications.
  • 3D-TEE is a valuable tool for diagnosing rare cardiac abnormalities like fistulas.
  • Early recognition and management of CCMA rupture are essential to prevent life-threatening conditions such as hemolytic anemia.

Keywords:
caseous calcification of the mitral annulushemolytic anemiatransesophageal echocardiography

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