Surgery Experience with Calcified Amorphous Tumor of the Mitral Valve Complicated by Infective Endocarditis

Cardiac calcified amorphous tumors (CAT) are non-neoplastic cardiac lesions composed of calcified nodules. These lesions are associated with underlying factors such as hypertension, diabetes mellitus, and end-stage renal dysfunction. However, its association with infective endocarditis remains unclear.

The patient was a 72-year-old woman with a medical history of diabetes mellitus, hypertension, and ossification of the posterior longitudinal ligament. However, no renal dysfunction was observed. For the past 2 months, she had been prescribed antibiotics for low-grade fever. The patient exhibited signs of cerebral and splenic infarctions, along with a vegetative mitral valve apparatus. Cardiac CT showed a posterior leaflet with a tumor-like appearance and calcification. Intraoperative findings revealed no calcification of the mitral annulus. However, the mitral valve leaflets were markedly thickened, with a vegetate attached to the posterior leaflet. The vegetation was then removed and the anterior leaflet was easily excised. The posterior leaflet, which was markedly thickened with calcification, was excised using a No. 15 scalpel and incised along its border with the left ventricular posterior wall. After irrigation, the left ventricular posterior wall and mitral annulus were covered with bovine pericardium and a 25-mm biological valve was implanted in the supra-annular position. The results of pathological and bacterial examinations were consistent with those of a case of CAT complicated by infective endocarditis. The patient's postoperative course was uncomplicated.

We encountered a rare case of CAT complicated by infective endocarditis. Complete resection of the CAT in combination with pericardial patch reconstruction of the left ventricular posterior wall, mitral annulus, and mitral valve replacement using a bioprosthesis yielded favorable results.