TCT-475 Natural History of Mitral Disease Associated With Mitral Annular Calcification

Background: Caseous calcification of the mitral annulus (CCMA) is believed to have a benign prognosis. Several authors have recommended conservative management in asymptomatic patients. However, the prevalence of cerebrovascular events (CVE) in patients with CCMA has never been evaluated before. The aims of this study are to investigate whether patients with CCMA are at increased risk of cerebral embolization, and to determine whether elective surgical resection of CCMA should be considered to prevent a cardioembolic stroke. Methods: A comprehensive literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, and Google Scholar using the following search queries: caseous calcification of the mitral annulus, intracardiac pseudotumor, mitral annular calcification, and cardioembolic stroke. Results: From our initial search that yielded 1,502 articles, we identified a total of 130 patients with CCMA reported in 86 publications. Literature review revealed that the prevalence of CVE associated with CCMA is 19.2% (25 of 130) which is significantly higher than the prevalence of CVE reported with mitral annular calcification (MAC), 11.8% (214 of 1818) (range 4.8% to 24.1%) (P = 0.01796) (odds ratio = 1.78; 0.95 confidence interval = 1.1278 – 2.8239). Only four of 25 (16.0%) patients with CCMA who suffered a CVE had history of atrial fibrillation (AF). Conclusion: Based on our review, it would be reasonable to consider elective surgical resection of CCMA in asymptomatic patients who are good surgical candidates, because patients with CCMA may be at increased risk of embolic strokes, which are unrelated to AF.

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Abstract 11452: Are Patients With Caseous Calcification of the Mitral Annulus But Without Atrial Fibrillation at Increased Risk of Cerebral Embolization?

Circulation ◽

10.1161/circ.130.suppl_2.11452 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Charles A Dietl ◽

Christopher M Hawthorn ◽

Veena Raizada

Keyword(s):

Atrial Fibrillation ◽

Mitral Annulus ◽

Mitral Annular Calcification ◽

Benign Condition ◽

Increased Risk ◽

Cerebral Embolization ◽

Mitral Annulus Calcification ◽

Unusual Variant ◽

History Of ◽

Annular Calcification

Background: Caseous calcification of the mitral annulus (CCMA) is very uncommon, and is frequently misdiagnosed as an intracardiac tumor, thrombus, abscess, or simply as mitral annular calcification (MAC). These masses are generally believed to have a benign prognosis. The aims of this study are to increase the awareness of this unusual variant of MAC, and to determine whether patients with CCMA are at increased risk of cerebral embolization in patients with or without atrial fibrillation (AF). Methods: A comprehensive literature search was done to determine whether patients with CCMA are at increased risk of cerebral embolization, using the following search modules: caseous calcification of the mitral annulus, mitral annular calcification, cerebral embolization with mitral annulus calcification, risk of stroke with mitral annular calcification. Results: Among the 496 articles listed in PubMed.gov, ScienceDirect.com, and Google Scholar, a total of 129 patients with CCMA were identified in 85 publications, and 31 articles were reviewed to evaluate the incidence of stroke in 1800 patients with MAC. Literature review revealed that the incidence of cerebrovascular events (CVE) associated with CCMA is 18.6% (24 of 129) which is even higher than the risk of embolic CVE reported in patients with MAC, 11.6% (209 of 1800) (range 4.8% to 24.1%). Only 2 of 24 patients (8.3%) with CCMA who suffered a CVE had history of AF, whereas the majority (22 of 24, or 91.7%) of CCMA patients with a CVE did not have AF. Conclusions: Despite the fact that several reports suggest that CCMA is a benign condition, CCMA may be potentially serious, because of the increased risk of cerebral embolization, even in patients without atrial fibrillation.

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Abstract 16851: Simultaneous Mitral Valve Replacement, Aortic Valve Replacement, Tricuspid Valve Repair, Left Atrial Appendage Ligation, Maze Procedure And Cabg In A 57-year Old Female With History Of Tavr And Severe Mitral Annular Calcification

Circulation ◽

10.1161/circ.144.suppl_2.16851 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Hassan Mehmood Lak ◽

Joshua Cohen ◽

Jean Pierre Iskandar ◽

Mohamed Gad ◽

Sanchit Chawla ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Tricuspid Regurgitation ◽

Mitral Stenosis ◽

Maze Procedure ◽

Mitral Annular Calcification ◽

Severe Tricuspid Regurgitation ◽

History Of ◽

Annular Calcification

Background: Open heart surgery is preferred for patients with multiple valvular issues with conflicting physiology. Case: A 57-year-old female with a past medical history of Type I Diabetes Mellitus complicated by kidney & pancreatic transplant in 1999 s/p failed kidney transplant in 2016 subsequently back on dialysis, aortic stenosis leading to Transcatheter Aortic Valve Replacement (TAVR) in 2016 who presented to the hospital for profound cardiogenic shock and was found to have severe tricuspid regurgitation, severe mitral stenosis secondary to mitral annular calcification with severe concentric hypertrophy of left ventricle. Decision Making: Her conflicting right and left heart physiology due to Tricuspid Regurgitation and Mitral Stenosis was very difficult to manage medically. She was not deemed a candidate for a heart transplant due to a history of a failed kidney transplant. She underwent surgery which included Mitral Valve Replacement, explant TAVR and repeat aortic valve replacement, Tricuspid repair, Left atrial appendage ligation and maze procedure, and CABG x1 with saphenous vein graft to PDA. She stayed on V-V extracorporeal membrane oxygenation (ECMO) post-operatively and was discharged on post-operative Day # 14. Conclusion: Severe tricuspid Regurgitation & coexisting mitral stenosis pose a dilemma for medical management and only feasible option is surgery which could be extremely challenging.

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Prevalence and prognosis of mitral disease due to mitral annular calcification

European Heart Journal ◽

10.1093/ehjci/ehaa946.2009 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Ahmed ◽

J.L Cavalcante ◽

M Goessl ◽

A.C Ukaigwe ◽

C.W Schmidt ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcomes ◽

Severe Heart Failure ◽

Valvular Regurgitation ◽

Mitral Annular Calcification ◽

Term Survival ◽

All Cause Mortality ◽

Mitral Disease ◽

Annular Calcification

Abstract Background While mitral annular calcification (MAC) is associated with valvular regurgitation or stenosis, this disease entity remains poorly understood. Purpose We sought to evaluate the prevalence and outcomes of patients with MAC. Methods Between January 2014 and December 2015, we reviewed all patients who underwent transthoracic echocardiography (TTE), and were identified as having MAC with either mitral regurgitation (MR) or stenosis (MS). Medical records were manually examined for demographics, morbidities, type and severity of mitral disease, and clinical outcomes for this cohort. Results Of 41,136 patients who had undergone TTE, MAC was identified in 2,855 (6.9%) patients, including 434 (1.0%) patients who had significant concomitant MR or MS (mean age, 78.9±10.4 years; 63% women). Severe heart failure (NYHA III or IV, 37%), renal failure (mean GFR, 47.3±15.7 ml/min), aortic stenosis (26% with severe stenosis or prior aortic intervention), diabetes (35%), and atrial fibrillation (50%) were common. The mean mitral gradient was 6.2±3.0 mmHg. Fifty-eight patients (13%) underwent surgical or transcatheter mitral valve intervention, with two procedural deaths (3.4%). Overall, the 3-year survival free of all-cause mortality was 53.9%, while freedom from all-cause mortality, hospitalization for heart failure, myocardial infarction and cerebrovascular accident was only 26.5% (Figure 1). Three-year survival free of all-cause mortality for those who had surgery or transcatheter therapy was better in comparison to those treated medically (77.6% vs. 50.3%; p<0.001). Conclusions Patients with MAC with MR or MS are common, have severe co-morbidities, and have poor long-term survival. Further study is needed to improve the clinical outcomes of these patients. KM curves for MAC and MR/MS patients Funding Acknowledgement Type of funding source: None

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How is the moral stance related to the intentional stance and group thinking?

Behavioral and Brain Sciences ◽

10.1017/s0140525x19002413 ◽

2020 ◽

Vol 43 ◽

Author(s):

Hannes Rakoczy

Keyword(s):

Natural History ◽

Social Cognitive ◽

Intentional Stance ◽

Cognitive Capacities ◽

Shared Intentionality ◽

History Of ◽

Group Thinking ◽

Moral Stance

Abstract The natural history of our moral stance told here in this commentary reveals the close nexus of morality and basic social-cognitive capacities. Big mysteries about morality thus transform into smaller and more manageable ones. Here, I raise questions regarding the conceptual, ontogenetic, and evolutionary relations of the moral stance to the intentional and group stances and to shared intentionality.

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