A Report of Two Cases with Caseous Annular Calcification of the Mitral Valve.
Likaj E. et al. - A Report of Two Cases with Caseous Annular Calcification of the Mitral Valve

Keywords

Caseous calcification
mitral annulus
surgical management

How to Cite

Likaj, E., Dumani, S., Mehmeti, A., Dibra, L., Bejko, E., Rruci, E., & Veshti, A. (2024). A Report of Two Cases with Caseous Annular Calcification of the Mitral Valve. Albanian Journal of Trauma and Emergency Surgery, 8(1), 1402-1404. https://doi.org/10.32391/ajtes.v8i1.372

Abstract

Introduction: Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annulus calcification, a chronic and degenerative mitral valve fibrous ring process. It usually carries a benign prognosis. The prevalence of CCMA is about 0.06%-0.07% of the population. CCMA is generally diagnosed incidentally and can be confused with other intracardiac masses such as cardiac tumors, abscesses, vegetation, or calcified thrombi. Multimodality imaging, including TEE, cardiac computed tomography, and cardiac magnetic nuclear resonance, can easily differentiate CCMA from other masses and help avoid unnecessary surgery. CCMA is typically located in the basal area of the posterior mitral valve, and the calcification seems like a round, large, soft mass with a central echo-dense location. CCMA may have a benign course, but it may sometimes be complicated with mitral valvular dysfunction, systemic embolization, or conduction abnormalities in the scenarios mentioned above, as well as when the diagnosis is unclear, surgery is indicated. Mitral valve replacement should be preferred compared to mitral valve repair.

Conclusions: It is important to note that the decision for mitral valve replacement, including CAC cases, should be individualized based on various factors, including the patient's clinical condition, symptoms, severity of valve disease, and associated comorbidities.

As scientific understanding and research progress, there may be ongoing developments and refinements in the conservative and surgical management of CCMA.

https://doi.org/10.32391/ajtes.v8i1.372
Likaj E. et al. - A Report of Two Cases with Caseous Annular Calcification of the Mitral Valve

References

Elgendy IY, Conti CR. Caseous calcification of the mitral annulus: a review. Clin Cardiol. 2013;36(10): E27-31. doi: 10.1002/clc.22199.

Pala AA, Iner H, Ercisli MA. Approach to an unusual cardiac mass: Mitral annulus caseoma. Braz J Cardiovasc Surg. 2020;35(1):120-22

Goldberg A, Singh G, Tracy M. Multiple cardioembolic strokes caused by caseous calcification of the mitral annulus. CASE (Phila). 2017;1(1):34-36

Thomas B, Danda N, John B. Caseous calcification of the mitral annulus presenting with symptomatic complete heart block. HeartRhythm Case Rep.2021;7(10):655-58

Davidson MJ, Cohn LH. Surgical treatment of caseous mitral valve annulus calcification. J Thorac Cardiovasc Surg. 2006;131(3):738-9. doi:10.1016/j.jtcvs.2005.11.025.

McKernan NP, Culp WC Jr, Knight WL, Johnston WE, Sniecinski RM, Lazar HL. CASE 2--2012 Intraoperative diagnosis and management of caseous mitral annulus calcification. J Cardiothorac Vasc Anesth.2012;26(2):327–32. doi:10.1053/j.jvca.2011.07.015

Pomerance A. Pathological and clinical study of calcification of the mitral valve ring. J Clin Pathol. 1970; 23:354–361.

Alkadhi H, Leschka S, Prêtre R, Perren A, Marincek B, Wildermuth S. Caseous calcification of the mitral annulus. J Thorac Cardiovasc Surg. 2005;129(6):1438-40. doi:10.1016/j.jtcvs.2004.11.051.

Harpaz D, Auerbach I, Vered Z, Motro M, Tobar A, Rosenblatt S. Caseous calcification of the mitral annulus: a neglected, unrecognized disease. J Am Soc Echocardiogr 2001;14:825–831.

Deluca G, Correale M, Ieva R, Del Salvatore B, Gramenzi S, Di Biase M. The incidence and clinical course of caseous calcification of the mitral annulus: a prospective echocardiographic study. J Am Soc Echocardiogr 2008;21:828–833.

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