Cor Vasa 2023, 65(4):710-714 | DOI: 10.33678/cor.2023.041
(Atheroma of mitral annulus - cause of progressive dyspnoea)
- Kardiochirurgické centrum, Fakultní nemocnice Ostrava, Ostrava
A 75-year-old female with progressive dyspnoea, having gradually increased during one year, was refer- red by her cardiologist to our University Hospital Ostrava to transoesophageal echocardiography. On the transthoracic echocardiography there was found a large tumor in the posterior mitral valve annulus with unknown etiology, tumor made mitral stenosis and regurgitation. In the differential diagnosis we think about myxoma, rare lipoma, and atheroma. We did not think about infective endocarditis (abscess) because there were no clinical symptoms. The patient was sent to magnetic resonance imaging, which didn't confirm stenosis of mitral valve. We didn't think about cardiosurgical treatment, because we were afraid of atrioventricular disconnection in the reason of localization. Next step was lung examination with physiological result. Coronarography had negative coronarogram, pathological vascularisation of the tumor from atrial branch of right coronary artery was detected. Computer tomography detected expansive process in the posterior basal segment of the left ventricle without calcification - we think about fibroma, myxoma in the differential diagnosis. Result of the CT was consulted with Radiodiagnostic Department of the University Hospital Vinohrady in Prague. We agreed that the tumor is atheroma of the mitral valve. Patient was indicated to surgical treatment - excision of the tumor and valve replacement. The operation was carried out in extracorporeal circulation and normothermiae. The cavity was full of caseos mass, blood, and calcification, drained by incision. Mitral valve was deformed by the tumor, the decision was the replacement by biological prosthesis SJM Epic No 27. Atrial fibrillation was the only one complication in the postoperative time. On the TTE there was no recidivism of the tumor. Dyspnea disappeared; physical condition was step by step better. The patient has been in care of her district cardiologist after a year of follow-up.
Keywords: Caseos tumor, Dyspnea, Mitral valve stenosis with regurgitation
Received: March 21, 2023; Revised: May 5, 2023; Accepted: May 8, 2023; Published: September 1, 2023 Show citation
References
- Elgendy IY, Conti CR. Caseous calcification of the mitral annulus: a review. Clin Cardiol 2013;36:E27-E31.
Go to original source...
Go to PubMed...
- Deluca G, Correale M, Ieva R, et al. The incidence and clinical course of caseous calcification of the mitral annulus: a prospective echocardiographic study. J Am Soc Echocardiogr 2008;21:828-833.
Go to original source...
Go to PubMed...
- Akram M, Hasanin A. Caseous mitral annular calcification: is it a benign condition? J Saudi Heart Assoc 2012;24:205-208.
Go to original source...
Go to PubMed...
- Alkadhi H, Leschka S, Pretre R, et al. Caseous calcification of the mitral annulus. J Thorac Cardiovasc Surg 2005;129:1438-1440.
Go to original source...
Go to PubMed...
- Harpaz D, Auerbach I, Vered Z, et al. Caseous calcification of the mitral annulus: a neglected, unrecognized diagnosis. J Am Soc Echocardiogr. 2001;14:825-831.
Go to original source...
Go to PubMed...
- Stamou SC, Braverman AC, Kouchoukos NT. Caseous calcification of the anterior mitral valve annulus presenting as intracardiac mass. J Thorac Cardiovasc Surg 2010;140:e9-e10.
Go to original source...
Go to PubMed...
- Karakus A, Tibilli H, Inanc IH, et al. An extensive caseous calcification of the mitral annulus complicated with severe mitral regurgitation. Echocardiography 2018;35:282-284.
Go to original source...
Go to PubMed...
- Ribeiro S, Salgado A, Salome N, et al. Caseous calcification of the mitral annulus: A multi-modality imaging perspective. Rev Port Cardiol 2012;31:313-316.
Go to original source...
Go to PubMed...
- McKernan NP, Culp WC Jr, Knight WL, et al. CASE 2-2012 intraoperative diagnosis and management of caseous calcification of the mitral annulus. J Cardiothorac Vasc Anesth 2012;26:327-332.
Go to original source...
Go to PubMed...
- de Vrey EA, Scholte AJ, Krauss XH, et al. Intracardiac pseudotumor caused by mitral annular calcification. Eur J Echocardiogr 2006;7:62-66.
Go to original source...
Go to PubMed...
- Fong LS, McLaughlin AJ, Okiwelu NL, et al. Surgical Management of Caseous Calcification of the Mitral Annulus. Ann Thorac Surg 2017;104:e291-e293.
Go to original source...
Go to PubMed...
- Ramaraj R, Manrique C, Hashemzadeh M, Movahed MR. Mitral annulus calcification is independently associated with all-cause mortality. Exp Clin Cardiol 2013;18:e5-e7.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.