scholarly journals Risk of Cerebral Embolization with Caseous Calcification of the Mitral Annulus: Review Article

2016 ◽  
Vol 10 (1) ◽  
pp. 221-232 ◽  
Author(s):  
Charles A. Dietl ◽  
Christopher M. Hawthorn ◽  
Veena Raizada
Keyword(s):  
Surgical Resection ◽  
Mitral Annulus ◽  
Cardioembolic Stroke ◽  
Mitral Annular Calcification ◽  
Asymptomatic Patients ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Cerebral Embolization ◽  
History Of ◽  
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.

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

Circulation ◽  
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.

scholarly journals Tumours of the heart: Diagnostic dilemma

2010 ◽  
Vol 138 (5-6) ◽  
pp. 343-346
Author(s):  
Ljiljana Rankovic ◽  
Milorad Borzanovic ◽  
Milan Vukovic ◽  
Aleksandar Radovic ◽  
Sinisa Gradinac
Keyword(s):  
Mitral Annulus ◽  
Mitral Valve Insufficiency ◽  
Tumor Formation ◽  
Elderly Persons ◽  
Mitral Annular Calcification ◽  
Diagnostic Dilemma ◽  
Valve Insufficiency ◽  
Degenerative Disorder ◽  
Mitral Apparatus ◽  
Annular Calcification

Introduction Mitral annular calcification is a degenerative process of the fibrosus support structure of the mitral apparatus, usually spreading over the posterior mitral leaflet. Case Outline A 66-year-old woman with shortness of breath and palpitations was referred to our institution. Echocardiography showed a round, echo-dense mass, resembling a tumour, in the posterior mitral annulus, with the third degree mitral regurgitation. Based on the findings, surgical treatment was suggested involving removal of the tumour and correction of mitral valve insufficiency. During surgery the posterior annulus was incised, whitish caseous material was aspirated and the developed cavity was closed. A bioprosthetic valve was placed in the mitral position. The aspirated material was sent to bacteriological and histological analysis. Eight days after surgery control echocardiography and CT scan of the heart showed absence of the mass. Pathohistological finding was nonspecific. Bacteriology showed Staphylococus spp. Thirteen days after surgery the patient was discharged in stabile condition. Conclusion Mitral annular calcification is a common degenerative disorder particularly in elderly persons. As the diagnosis very often remains unrecognised imitating a tumor formation, precise diagnostics is necessary before possible surgery. .

Impact of pretransplant mitral annular calcification on the incidence of cardiac events after renal transplantation

2019 ◽  
Vol 35 (3) ◽  
pp. 526-533 ◽  
Author(s):  
Nadia El Hangouche ◽  
Javier Gomez ◽  
Addis Asfaw ◽  
Jayakumar Sreenivasan ◽  
Tauseef Akhtar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Transplantation ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Cardiac Events ◽  
Mitral Annular Calcification ◽  
Post Transplant ◽  
Increased Risk ◽  
Annular Calcification

Abstract Background Mitral annular calcification (MAC) is associated with increased risk of major adverse cardiac events. We hypothesized that MAC, identified on a pretransplant transthoracic echocardiography (TTE), is predictive of cardiac events following renal transplantation (RT). Methods In a retrospective cohort of consecutive RT recipients, pretransplant MAC presence and severity were determined on TTE performed within 1 year prior to transplant. MAC severity was quantified based on the circumferential MAC extension relative to the mitral valve annulus. Post-transplant cardiac risk was assessed using the sum of risk factors (range: 0–8) set forth by the American Heart Association/American College of Cardiology Foundation consensus statement on the assessment of RT candidates. Subjects underwent pretransplant stress single-photon emission computed tomography myocardial perfusion imaging and followed for post-transplant composite outcome of cardiac death or myocardial infarction (CD/MI). Results Among 336 subjects (60.5% men; mean age 52 ± 12 years), MAC was present in 78 (23%) patients. During a mean follow-up of 3.1 ± 1.9 years, a total of 70 events were observed. Patients with MAC had a higher event rate compared with those without MAC (34.6% versus 17.8%, log-rank P = 0.001). There was a stepwise increase in CD/MI risk with increasing MAC severity (P for trend = 0.002). MAC-associated risk remained significant after adjusting for sex, duration of dialysis, sum of risk factors, ejection fraction and perfusion abnormality burden, providing an incremental prognostic value to these parameters (Δχ2 =4.63; P = 0.031). Conclusion Among RT recipients, the burden of pretransplant MAC is an independent predictor of post-transplant risk of CD/MI. MAC should be considered in the preoperative assessment of RT candidates.

scholarly journals Recurrent ST-Elevation Myocardial Infarction: Case Report of A Rare Complication of Caseous Mitral Annular Calcification

2021 ◽  
Author(s):  
Nikhil Singh ◽  
Atman P Shah ◽  
Gianluca Torregrossa ◽  
John E Blair
Keyword(s):  
Myocardial Infarction ◽  
Mitral Valve ◽  
Recurrent Events ◽  
Early Recognition ◽  
Rare Complication ◽  
Mitral Annular Calcification ◽  
Imaging Evaluation ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
Annular Calcification

Abstract Background Caseous mitral annular calcification is an under-diagnosed division of calcific mitral valve disease that has recently been reported to have increased propensity for embolic disease. Early recognition of this entity as a cause of embolic disease can lead to prevention of occlusive vascular disease and long-standing complications. Case Summary We present the case of a patient with end-stage renal disease who presented for evaluation of chest pain and was found to have ST-segment myocardial infarction. Despite thrombectomy and stenting, he had multiple recurrent events, and imaging evaluation demonstrated caseous mitral annular calcification with mobile components. He was taken for surgical replacement of the mitral valve, with pathology confirming diagnosis. Discussion Caseous mitral annular calcification may represent an increased risk of embolic disease. Better understanding of this pathology and it’s propensity for embolic disease will be important to best determine treatment plans and timing of operative intervention.

Cavitron ultrasonic surgical aspirator for mitral annular decalcification

2021 ◽  
Keyword(s):  
Mitral Annulus ◽  
Mitral Valve Surgery ◽  
Mitral Annular Calcification ◽  
Video Tutorial ◽  
Cavitron Ultrasonic Surgical Aspirator ◽  
Consensus Strategy ◽  
Annular Calcification ◽  
Ultrasonic Surgical Aspirator ◽  
Patient Presentation ◽  
Severe Calcification

Mitral valve surgery can be especially difficult in patients with mitral annular calcification. Not only is it associated with higher morbidity and mortality, but there is no consensus strategy for the treatment of mitral annular calcification, which may render some patients inoperable. We describe a case of severe mitral annular calcification successfully treated with the cavitron ultrasonic surgical aspirator. We demonstrate the proper technique for and the efficacy of using this instrument for decalcification of the mitral annulus. The video tutorial includes the patient presentation, preoperative and postoperative imaging, and the proper surgical technique for cavitron ultrasonic surgical aspirator-assisted mitral annular decalcification. With the proper technique, the cavitron ultrasonic surgical aspirator may mitigate the risk of surgical complications associated with severe calcification of the mitral annulus.

scholarly journals Mitral annular calcification: Can CMR be useful in identifying caseous necrosis?

2019 ◽  
Vol 11 (1) ◽  
pp. 71-73
Author(s):  
Matteo Gravina ◽  
Grazia Casavecchia ◽  
Vincenzo Manuppelli ◽  
Antonio Totaro ◽  
Luca Macarini ◽  
...  
Keyword(s):  
Mitral Annulus ◽  
Mitral Annular Calcification ◽  
Caseous Necrosis ◽  
Intracardiac Mass ◽  
Fibrous Cap ◽  
Posterior Mitral Leaflet ◽  
Extensive Calcification ◽  
Mitral Annulus Calcification ◽  
Definition Of ◽  
Annular Calcification

Mitral annular calcification (MAC) can resemble an intracardiac mass and it is defined as a chronic degeneration of the mitral annulus. Often reported is caseous mitral annulus calcification (CMAC), a periannular, extensive calcification resembling a tumor. We report the case of a 68-year-old woman who had been hospitalized for palpitations and dyspnea. The transthoracic and transesophageal echocardiography revealed a non-homogeneous, slightly mobile, round mass, attached to the ventricular side of posterior mitral leaflet, with central echo-lucent area and without acoustic shadowing. Therefore, a cardiac magnetic resonance (CMR) was performed; delayed enhancement sequences showed a non-enhanced central core surrounded by a hyperenhanced rim (fibrous cap). To confirm the diagnosis, a multidetector computed tomography (MDCT) was performed; the MDCT showed a hyperdense mass with a hypodense center and a calcified peripheral rim. The central content had heterogeneous fluid density without significant contrast enhancement. The MDCT findings were considered highly suggestive of CMAC. CMR may be useful for the identification and definition of pericardial and myocardial masses and CMAC.

P681Acute Myocardial Infarction in patients with Leukaemia: A national analysis of prevalence, predictors and outcomes in United States hospitalisations (2004 to 2014)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M O Mohamed ◽  
J C Lopez-Mattei ◽  
C A Iliescu ◽  
P Purwani ◽  
A Bharadwaj ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Coronary Intervention ◽  
Cardiac Complications ◽  
Risk Of Mortality ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
History Of ◽  
National Analysis

Abstract Background Patients with leukaemia are at increased risk of cardiovascular events. There is limited outcomes data for patients with a history of leukaemia who present with an acute myocardial infarction (AMI). Purpose To examine the prevalence and clinical characteristics of patients with leukaemia presenting with AMI, and evaluate differences in clinical outcomes according to the subtype of leukaemia in comparison to patients without leukaemia. Methods We analysed the Nationwide Inpatient Sample (2004–2014) for patients with a primary discharge diagnosis of AMI and concomitant leukaemia, and further stratified according to the subtype of leukaemia into 4 groups; AML; ALL; CML; and CLL. Multiple logistic regression was conducted to identify the association between leukaemia and major acute cardiovascular and cerebrovascular events (MACCE; composite of mortality, stroke and cardiac complications) and bleeding. Results Out of 6,750,927 AMI admissions, a total of 21,694 patients had a leukaemia diagnosis. The leukaemia group experienced higher rates of MACCE (11.8% vs. 7.8%), mortality (10.3% vs. 5.8%) and bleeding (5.6% vs. 5.3%). Following adjustments, leukaemia was independently associated with increased odds of MACCE (OR 1.26 [1.20,1.31]) and mortality (OR 1.43 [1.37,1.50]) without an increased risk of bleeding (OR 0.86 [0.81,0.92]). Acute myeloid leukaemia (AML) was associated with approximately three-fold risk of MACCE (RR 2.81 [2.51, 3.13]) and a four-fold risk of mortality (RR 3.75 [3.34, 4.22]) (Figure 1). Patients with leukaemia were less likely to undergo coronary angiography (CA) (48.5% vs. 64.5%) and percutaneous coronary intervention (PCI) (28.2% vs. 42.9%) compared to those without leukaemia. Figure 1.Relative risk of adverse events Conclusion Patients with leukaemia, especially those with AML, are associated with poor clinical outcomes after AMI, and are less likely to receive CA and PCI compared to those without leukaemia. A multi-disciplinary approach between cardiologists and haematology oncologists may improve the outcomes of patients with leukaemia after AMI.

scholarly journals CEREBRAL EMBOLIZATION FROM CASEOUS MITRAL ANNULAR CALCIFICATION

2017 ◽  
Vol 69 (11) ◽  
pp. 2180
Author(s):  
Maygen Del Castillo ◽  
David Burkland ◽  
George Letsou ◽  
Raymond Stainback
Keyword(s):  
Mitral Annular Calcification ◽  
Cerebral Embolization ◽  
Annular Calcification

scholarly journals Point-of-care Ultrasound in the Evaluation of Mitral Valve Regurgitation and Mitral Annular Calcification

2020 ◽  
Vol 4 (4) ◽  
pp. 628-629
Author(s):  
Benjamen Schoenberg ◽  
Marwan Alkhattabi ◽  
Shadi Lahham
Keyword(s):  
Mitral Valve ◽  
Point Of Care ◽  
Mitral Valve Regurgitation ◽  
Point Of Care Ultrasound ◽  
Posterior Leaflet ◽  
Mitral Annular Calcification ◽  
Increased Risk ◽  
Valve Pathology ◽  
Annular Calcification

Case Presentation: A 77-year-old female presented to the emergency department (ED) with chest pain. Cardiac point-of-care ultrasound (POCUS) was performed and demonstrated a hyperechoic structure on the posterior leaflet of the mitral valve. Admission to cardiology and echocardiogram revealed moderately decreased mobility of the posterior leaflet, mitral annular calcification, and severe mitral regurgitation. Discussion: These findings highlight the role of POCUS in identifying mitral valve pathology in the ED, ultimately leading to appropriate disposition and management. Mitral annular calcification can lead to significant manifestations including mitral stenosis or regurgitation, and advanced cases have been associated with an increased risk of infective endocarditis, thrombosis, and arrhythmia.

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